Rotation features for ultrasonic surgical instrument

ABSTRACT

An apparatus includes a shaft assembly, an ultrasonic blade, and a clamp assembly. The shaft assembly includes an acoustic waveguide operable to transmit ultrasonic vibrations to the blade. The clamp assembly includes a clamp arm pivotable toward and away from the blade about a pivot axis, to clamp tissue between the clamp arm and the blade. A rotation feature may provide rotation of the blade relative to the clamp arm about the longitudinal axis of the waveguide. Alternatively, the rotation feature may provide rotation of the clamp arm relative to the blade about the longitudinal axis. The rotation feature may be driven based on pivotal positioning of the clamp arm relative to the blade about the pivot axis. The rotation feature may selectively lock and unlock the angular position of either the blade or the clamp arm about the longitudinal axis at any of a number of predetermined angular positions.

BACKGROUND

A variety of surgical instruments include an end effector having a bladeelement that vibrates at ultrasonic frequencies to cut and/or sealtissue (e.g., by denaturing proteins in tissue cells). These instrumentsinclude piezoelectric elements that convert electrical power intoultrasonic vibrations, which are communicated along an acousticwaveguide to the blade element. The precision of cutting and coagulationmay be controlled by the surgeon's technique and adjusting the powerlevel, blade edge, tissue traction and blade pressure.

Examples of ultrasonic surgical instruments include the HARMONIC ACE®Ultrasonic Shears, the HARMONIC WAVE® Ultrasonic Shears, the HARMONICFOCUS® Ultrasonic Shears, and the HARMONIC SYNERGY® Ultrasonic Blades,all by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. Further examplesof such devices and related concepts are disclosed in U.S. Pat. No.5,322,055, entitled “Clamp Coagulator/Cutting System for UltrasonicSurgical Instruments,” issued Jun. 21, 1994, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 5,873,873, entitled“Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp Mechanism,”issued Feb. 23, 1999, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 5,980,510, entitled “Ultrasonic ClampCoagulator Apparatus Having Improved Clamp Arm Pivot Mount,” filed Oct.10, 1997, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,325,811, entitled “Blades with Functional BalanceAsymmetries for use with Ultrasonic Surgical Instruments,” issued Dec.4, 2001, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,773,444, entitled “Blades with Functional BalanceAsymmetries for Use with Ultrasonic Surgical Instruments,” issued Aug.10, 2004, the disclosure of which is incorporated by reference herein;and U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool withUltrasound Cauterizing and Cutting Instrument,” issued Aug. 31, 2004,the disclosure of which is incorporated by reference herein.

Still further examples of ultrasonic surgical instruments are disclosedin U.S. Pub. No. 2006/0079874, entitled “Tissue Pad for Use with anUltrasonic Surgical Instrument,” published Apr. 13, 2006, the disclosureof which is incorporated by reference herein; U.S. Pub. No.2007/0191713, entitled “Ultrasonic Device for Cutting and Coagulating,”published Aug. 16, 2007, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2007/0282333, entitled “UltrasonicWaveguide and Blade,” published Dec. 6, 2007, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2008/0200940, entitled“Ultrasonic Device for Cutting and Coagulating,” published Aug. 21,2008, the disclosure of which is incorporated by reference herein; U.S.Pub. No. 2009/0105750, entitled “Ergonomic Surgical Instruments,”published Apr. 23, 2009, now U.S. Pat. No. 8,623,027, issued on Jan. 7,2014, the disclosure of which is incorporated by reference herein; U.S.Pub. No. 2010/0069940, entitled “Ultrasonic Device for FingertipControl,” published Mar. 18, 2010, now U.S. Pat. No. 9,023,071, issuedon May 5, 2015, the disclosure of which is incorporated by referenceherein; and U.S. Pub. No. 2011/0015660, entitled “Rotating TransducerMount for Ultrasonic Surgical Instruments,” published Jan. 20, 2011, nowU.S. Pat. No. 8,461,744 issued on Jun. 11, 2013, the disclosure of whichis incorporated by reference herein; U.S. Pub. No. 2012/0029546,entitled “Ultrasonic Surgical Instrument Blades,” published Feb. 2,2012, now U.S. Pat. No. 8,591,536, issued on Nov. 26, 2013, thedisclosure of which is incorporated by reference herein; and U.S. patentapplication Ser. No. 14/031,665, entitled “Alignment Features forUltrasonic Surgical Instrument,” filed Sep. 19, 2013, published as U.S.Pub. No. 2015/0080925 on Mar. 19, 2015, the disclosure of which isincorporated by reference herein.

Some of ultrasonic surgical instruments may include a cordlesstransducer such as that disclosed in U.S. Pub. No. 2012/0112687,entitled “Recharge System for Medical Devices,” published May 10, 2012,now U.S. Pat. No. 9,381,058, issued on Jul. 5, 2016, the disclosure ofwhich is incorporated by reference herein; U.S. Pub. No. 2012/0116265,entitled “Surgical Instrument with Charging Devices,” published May 10,2012, the disclosure of which is incorporated by reference herein;and/or U.S. Pat. App. No. 61/410,603, filed Nov. 5, 2010, entitled“Energy-Based Surgical Instruments,” the disclosure of which isincorporated by reference herein.

Additionally, some ultrasonic surgical instruments may include anarticulating shaft section. Examples of such ultrasonic surgicalinstruments are disclosed in U.S. patent application Ser. No.13/538,588, filed Jun. 29, 2012, entitled “Surgical Instruments withArticulating Shafts,” now U.S. Pat. No. 9,393,037, issued on Jul. 19,2016, the disclosure of which is incorporated by reference herein; andU.S. patent application Ser. No. 13/657,553, filed Oct. 22, 2012,entitled “Flexible Harmonic Waveguides/Blades for Surgical Instruments,”now U.S. Pat. No. 9,095,367, issued on Aug. 4, 2015, the disclosure ofwhich is incorporated by reference herein.

Some ultrasonic surgical instruments may include a clamping feature tocompress tissue against the ultrasonic blade of the end effector.Examples of such an arrangement (sometimes referred to as a clampcoagulator shears or an ultrasonic transector) are disclosed in U.S.Pat. No. 5,322,055, entitled “Clamp Coagulator/Cutting System forUltrasonic Surgical Instruments,” issued Jun. 21, 1994, the disclosureof which is incorporated by reference herein; U.S. Pat. No. 5,873,873,entitled “Ultrasonic Clamp Coagulator Apparatus Having Improved ClampMechanism,” issued Feb. 23, 1999, the disclosure of which isincorporated by reference herein; and U.S. Pat. No. 6,325,811, entitled“Blades with Functional Balance Asymmetries for use with UltrasonicSurgical Instruments,” issue Dec. 4, 2001, the disclosure of which isincorporated by reference herein. Some versions of clamp coagulatorshears utilize handles that are of either a pistol or scissors gripdesign. The scissor grip designs may have one thumb or finger grip thatis immovable and fixed to the housing; and one movable thumb or fingergrip. Some designs have scissor arms that extend from the grips, withone of the arms rotating around a fixed pivot or rotation point that isperpendicular to the longitudinal axis of the working element. Thepistol grip designs may have a trigger that is pivotable toward and awayfrom a pistol grip to pivotally drive a clamp arm. The operator may thussqueeze a handgrip or other feature to drive the clamp arm, to therebypivot the clamp pad toward the blade.

While several surgical instruments and systems have been made and used,it is believed that no one prior to the inventors has made or used theinvention described in the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims which particularly pointout and distinctly claim this technology, it is believed this technologywill be better understood from the following description of certainexamples taken in conjunction with the accompanying drawings, in whichlike reference numerals identify the same elements and in which:

FIG. 1 depicts a side elevational view of an exemplary surgicalinstrument;

FIG. 2 depicts a perspective view of the end effector of the instrumentof FIG. 1, in an open configuration;

FIG. 3A depicts a side cross-sectional view of the end effector of FIG.2, in the open configuration;

FIG. 3B depicts a side cross-sectional view of the end effector of FIG.2, in a closed configuration;

FIG. 4 depicts a perspective view of another exemplary surgicalinstrument;

FIG. 5 depicts a side elevational view of the end effector of theinstrument of FIG. 4, in a closed configuration;

FIG. 6A depicts a perspective view of the end effector of FIG. 5, in anopen configuration;

FIG. 6B depicts a perspective view of the end effector of FIG. 5, in aclosed configuration;

FIG. 7A depicts a cross-sectional view of a variation of the instrumentof FIG. 4 having an exemplary ultrasonic blade rotation mechanism in afirst configuration;

FIG. 7B depicts a cross-sectional view of the instrument of FIG. 7A withthe ultrasonic blade rotation mechanism in a second configuration;

FIG. 8 depicts a perspective view of another variation of the instrumentof FIG. 4 having an exemplary alternative ultrasonic blade rotationmechanism;

FIG. 9 depicts a cross-sectional view of the instrument of FIG. 8, takenalong line 9-9 of FIG. 8;

FIG. 10 depicts a side elevational view of another variation of theinstrument of FIG. 4 having another exemplary alternative ultrasonicblade rotation mechanism;

FIG. 11A depicts a side elevational view of the instrument of FIG. 10,with the instrument in an open configuration and with an ultrasonicblade in a first rotational position;

FIG. 11B depicts a side elevational view of the instrument of FIG. 10,with the instrument in a first closed configuration and with theultrasonic blade in the first rotational position;

FIG. 11C depicts a side elevational view of the instrument of FIG. 10,with the instrument in a second closed configuration and with theultrasonic blade rotated into a second rotational position;

FIG. 11D depicts a side elevational view of the instrument of FIG. 10,with the instrument in the second closed configuration with theultrasonic blade rotated into a third rotational position;

FIG. 12A depicts a side elevational view of another variation of theinstrument of FIG. 4 having yet another exemplary alternative ultrasonicblade rotation mechanism, with the instrument in an open configuration;

FIG. 12B depicts a side elevational view of the instrument of FIG. 12A,with the instrument moved into a closed configuration;

FIG. 13A depicts a cross-sectional view of the instrument of FIG. 12A,with the instrument in the open configuration and with an ultrasonicblade in a first rotational position;

FIG. 13B depicts a cross-sectional view of the instrument of FIG. 12A,with the instrument moved into the closed configuration and with theultrasonic blade rotated into a second rotational position;

FIG. 14 depicts a perspective view of another variation of theinstrument of FIG. 4 having yet another exemplary alternative ultrasonicblade rotation mechanism;

FIG. 15A depicts a cross-sectional view of the instrument of FIG. 14,the instrument in an open configuration and with an ultrasonic blade ina first rotational position;

FIG. 15B depicts a cross-sectional view of the instrument of FIG. 14,with the instrument moved into a partially closed configuration and withthe ultrasonic blade rotated into a second rotational position;

FIG. 15C depicts a cross-sectional view of the instrument of FIG. 14,with the instrument moved into a completely dosed configuration and withthe ultrasonic blade rotated into a third rotational position;

FIG. 16 depicts a perspective view of a barrel cam of an ultrasonicblade rotation mechanism suitable for incorporation into the instrumentof FIG. 1;

FIG. 17A depicts a perspective view of the barrel cam of FIG. 16 and anultrasonic blade, with the ultrasonic blade in a first longitudinalposition and in a first rotational position;

FIG. 17B depicts a perspective view of the barrel cam of FIG. 16 and theultrasonic blade, with the ultrasonic blade moved into a secondlongitudinal position and rotated into a second rotational position;

FIG. 18 depicts a perspective view of an inner tube of an ultrasonicblade rotation mechanism suitable for incorporation into the instrumentof FIG. 1;

FIG. 19A depicts a perspective view of the inner tube of FIG. 18 and anultrasonic blade, with the inner tube in a first longitudinal positionand with the ultrasonic blade in a first rotational position;

FIG. 19B depicts a perspective view of the inner tube of FIG. 18 and theultrasonic blade, with the inner tube moved into a second longitudinalposition and with the ultrasonic blade rotated into a second rotationalposition;

FIG. 20 depicts a perspective view of an inner tube and a yoke of anultrasonic blade rotation mechanism suitable for incorporation into theinstrument of FIG. 1;

FIG. 21A depicts a perspective view of the inner tube of FIG. 20 and anultrasonic blade, with the yoke in a first longitudinal position andwith the inner tube and the ultrasonic blade in a first rotationalposition;

FIG. 21B depicts a perspective view of the inner tube of FIG. 20 and theultrasonic blade, with the yoke moved into a second longitudinalposition and with the inner tube and the ultrasonic blade rotated into asecond rotational position;

FIG. 22A depicts a cross-sectional view of yet another ultrasonic bladerotation mechanism suitable for incorporation into the instruments ofFIG. 1 and FIG. 4, with a pin of the ultrasonic blade rotation mechanismin a first vertical position and with an ultrasonic blade in a firstrotational position;

FIG. 22B depicts a cross-sectional view of the ultrasonic blade rotationmechanism of FIG. 22A, with the pin moved into a second verticalposition and with the ultrasonic blade rotated into a second rotationalposition;

FIG. 23 depicts a perspective view of another variation of theinstrument of FIG. 4 having an exemplary clamp arm rotation mechanism;

FIG. 24A depicts a cross-sectional view of a locking member of the clamparm rotation mechanism of FIG. 23 in a first longitudinal position;

FIG. 24B depicts a cross-sectional view of the locking member of FIG.24A moved into a second longitudinal position;

FIG. 25A depicts a cross-sectional view of clamp arm rotation mechanismof the instrument of FIG. 23, with the clamp arm in a first rotationalposition;

FIG. 25B depicts a cross-sectional view of the ultrasonic blade and theclamp arm of the instrument of FIG. 23, with the clamp arm in a firstrotational position;

FIG. 25C depicts a cross-sectional view of clamp arm rotation mechanismof FIG. 25A, with the clamp arm moved into a second rotational position;

FIG. 25D depicts a cross-sectional view of the ultrasonic blade and theclamp arm of FIG. 25B, with the clamp arm moved into the secondrotational position;

FIG. 25E depicts a cross-sectional view of clamp arm rotation mechanismof FIG. 25A, with the clamp arm moved into a third rotational position;

FIG. 25F depicts a cross-sectional view of the ultrasonic blade and theclamp arm of FIG. 25B, with the clamp arm moved into the thirdrotational position;

FIG. 26 depicts a partial exploded perspective view of another variationof the instrument of FIG. 4 having an exemplary alternative clamp armrotation mechanism;

FIG. 27A depicts a perspective view of the instrument of FIG. 26 withthe instrument in a closed configuration;

FIG. 27B depicts a perspective view of the instrument of FIG. 26 withthe instrument moved into an open configuration;

FIG. 28A depicts a top plan view of the instrument of FIG. 26 with theclamp arm in a first lateral rotational position;

FIG. 28B depicts a top plan view of the instrument of FIG. 26 with theclamp arm moved into a second lateral rotational position;

FIG. 28C depicts a top plan view of the instrument of FIG. 26 with theclamp arm moved into a third lateral rotational position;

FIG. 29 depicts a perspective view of another variation of theinstrument of FIG. 4 having another exemplary alternative clamp armrotation mechanism;

FIG. 30 depicts a cross-sectional view of the instrument of FIG. 29;

FIG. 31A depicts a side elevational view of the instrument of FIG. 29,with the clamp arm in a first rotational position;

FIG. 31B depicts a side elevational view of the instrument of FIG. 29,with the clamp arm moved into a second rotational position;

FIG. 31C depicts a side elevational view of the instrument of FIG. 29,with the clamp arm moved into a third rotational position;

FIG. 32 depicts a perspective view of an exemplary ultrasonic bladesuitable for incorporation into the instruments of FIG. 1 and FIG. 4having a coupling feature to provide for rotation of the ultrasonicwaveguide;

FIG. 33A depicts a cross-sectional view of a variation of the instrumentof FIG. 4 with the coupling feature of FIG. 32, with the ultrasonicblade in a first rotational position;

FIG. 33B depicts a cross-sectional view of the ultrasonic blade and theclamp arm of the instrument of FIG. 33A, with the ultrasonic blade in afirst rotational position;

FIG. 33C depicts a cross-sectional view of the instrument of FIG. 33A,with the ultrasonic blade in moved into a second rotational position;

FIG. 33D depicts a cross-sectional view of the ultrasonic blade and theclamp arm of FIG. 33B, with the ultrasonic blade moved into the secondrotational position;

FIG. 33E depicts a cross-sectional view of the instrument of FIG. 33A,with the ultrasonic blade moved into a third rotational position;

FIG. 33F depicts a cross-sectional view of the ultrasonic blade and theclamp arm of FIG. 33B, with the ultrasonic blade moved into the thirdrotational position;

FIG. 34 depicts a cross-sectional view of another variation of theinstrument of FIG. 4 having an exemplary alternative coupling feature toprovide for rotation of the ultrasonic waveguide;

FIG. 35 depicts a perspective view of another variation of theinstrument of FIG. 4 having an exemplary alternative ultrasonic blade;

FIG. 36 depicts a top view of the ultrasonic blade of FIG. 35;

FIG. 37 depicts a cross-sectional view of the ultrasonic blade of FIG.35, taken along line 37-37 of FIG. 36;

FIG. 38 depicts a perspective view of another variation the instrumentof FIG. 4 having an exemplary alternative clamp pad;

FIG. 39 depicts a top view of the clamp pad of FIG. 38;

FIG. 40 depicts a diagram of electrical impedance sensed by the clamppad of FIG. 38;

FIG. 41A depicts a side elevational view of another variation of theinstrument of FIG. 4 having an exemplary pivoting cam mechanism, withthe instrument in an open configuration;

FIG. 41B depicts a side elevational view of the instrument of FIG. 41A,with the instrument moved into a partially closed configuration;

FIG. 41C depicts a side elevational view of the instrument of FIG. 41A,with the instrument moved into a completely closed position;

FIG. 42 depicts a perspective view of an exemplary pin of the pivotingcam mechanism of the instrument of FIG. 41A; and

FIG. 43 depicts a perspective view of an exemplary alternative pin thatmay be used with the pivoting cam mechanism of the instrument of FIG.41A.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the technology may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presenttechnology, and together with the description serve to explain theprinciples of the technology; it being understood, however, that thistechnology is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the technology shouldnot be used to limit its scope. Other examples, features, aspects,embodiments, and advantages of the technology will become apparent tothose skilled in the art from the following description, which is by wayof illustration, one of the best modes contemplated for carrying out thetechnology. As will be realized, the technology described herein iscapable of other different and obvious aspects, all without departingfrom the technology. Accordingly, the drawings and descriptions shouldbe regarded as illustrative in nature and not restrictive.

It is further understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Thefollowing-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

For clarity of disclosure, the terms “proximal” and “distal” are definedherein relative to a human or robotic operator of the surgicalinstrument. The term “proximal” refers the position of an element closerto the human or robotic operator of the surgical instrument and furtheraway from the surgical end effector of the surgical instrument. The term“distal” refers to the position of an element closer to the surgical endeffector of the surgical instrument and further away from the human orrobotic operator of the surgical instrument.

I. Exemplary Ultrasonic Surgical Instrument

FIGS. 1-6B illustrate exemplary ultrasonic surgical instruments (10,100). At least part of each instrument (10, 100) may be constructed andoperable in accordance with at least some of the teachings of U.S. Pat.Nos. 5,322,055; 5,873,873; 5,980,510; 6,325,811; 6,773,444; 6,783,524;U.S. Pub. No. 2006/0079874; U.S. Pub. No. 2007/0191713; U.S. Pub. No.2007/0282333; U.S. Pub. No. 2008/0200940; U.S. Pub. No. 2009/0105750;now U.S. Pat. No. 8,623,027, issued on Jan. 7, 2014; U.S. Pub. No.2010/0069940; now U.S. Pat. No. 9,023,071, issued on May 5, 2015; U.S.Pub. No. 2011/0015660; now U.S. Pat. No. 8,461,744, issued on Jun. 11,2013; U.S. Pub. No. 2012/0112687; now U.S. Pat. No. 9,381,058, issued onJul. 5, 2016; U.S. Pub. No. 2012/0116265; U.S. patent application Ser.No. 13/538,588, now U.S. Pat. No. 9,393,037, issued on Jul. 19, 2016;U.S. patent application Ser. No. 13/657,553, now U.S. Pat. No.9,095,367, issued on Aug. 4, 2015; U.S. Pat. App. No. 61/410,603; and/orU.S. patent application Ser. No. 14/028,717, published as U.S. Pub. No.2015/0080924 on Mar. 19, 2015. The disclosures of each of the foregoingpatents, publications, and applications are incorporated by referenceherein. As described therein and as will be described in greater detailbelow, each instrument (10, 100) is operable to cut tissue and seal orweld tissue (e.g., a blood vessel, etc.) substantially simultaneously.It should also be understood that instruments (10, 100) may have variousstructural and functional similarities with the HARMONIC ACE® UltrasonicShears, the HARMONIC WAVE® Ultrasonic Shears, the HARMONIC FOCUS®Ultrasonic Shears, and/or the HARMONIC SYNERGY® Ultrasonic Blades.Furthermore, instruments (10, 100) may have various structural andfunctional similarities with the devices taught in any of the otherreferences that are cited and incorporated by reference herein.

To the extent that there is some degree of overlap between the teachingsof the references cited herein, the HARMONIC ACE® Ultrasonic Shears, theHARMONIC WAVE® Ultrasonic Shears, the HARMONIC FOCUS® Ultrasonic Shears,and/or the HARMONIC SYNERGY® Ultrasonic Blades, and the followingteachings relating to instruments (10, 100), there is no intent for anyof the description herein to be presumed as admitted prior art. Severalteachings herein will in fact go beyond the scope of the teachings ofthe references cited herein and the HARMONIC ACE® Ultrasonic Shears, theHARMONIC WAVE® Ultrasonic Shears, the HARMONIC FOCUS® Ultrasonic Shears,and the HARMONIC SYNERGY® Ultrasonic Blades.

A. Exemplary Ultrasonic Surgical Instrument for Minimally InvasiveSurgical Procedures

FIG. 1 illustrates an exemplary ultrasonic surgical instrument (10) thatis configured to be used in minimally invasive surgical procedures(e.g., via a trocar or other small diameter access port, etc.).Instrument (10) of this example comprises a handle assembly (20), ashaft assembly (30), and an end effector (40). As shown in FIGS. 2-3B,shaft assembly (30) comprises an outer sheath (32), an inner tube (34)slidably disposed within outer sheath (32), and a waveguide (38)disposed within inner tube (34). As will be discussed in more detailbelow, longitudinal translation of inner tube (34) relative to outersheath (32) causes actuation of clamp arm (44) at end effector (40).Handle assembly (20) comprises a body (22) including a pistol grip (24)and a pair of buttons (26). Handle assembly (20) also includes a trigger(28) that is pivotable toward and away from pistol grip (24). It shouldbe understood, however, that various other suitable configurations maybe used, including but not limited to a scissor grip configuration. Inthe present example, a resilient member biases trigger (28) away frompistol grip (24). Trigger (28) is pivotable toward pistol grip (24) todrive inner tube (34) proximally relative to outer sheath (32). Whentrigger (28) is thereafter released or driven away from pistol grip(24), inner tube (34) is driven distally relative to outer sheath (32).By way of example only, trigger (28) may be coupled with inner tube (34)in accordance with the teachings of various references cited herein.Other suitable ways in which trigger (28) may be coupled with inner tube(34) will be apparent to those of ordinary skill in the art in view ofthe teachings herein.

As shown in FIGS. 2-3B, end effector (40) includes an ultrasonic blade(42) and a pivoting clamp arm (44). Clamp arm (44) includes a clamp pad(46) facing ultrasonic blade (42). Clamp arm (44) is pivotably coupledwith a distal end of outer sheath (32) of shaft assembly (30), aboveultrasonic blade (42), via a pin (33). A distal end of inner tube (34)is pivotably coupled with a proximal end of clamp arm (44), belowultrasonic blade (42), via another pin (35). Thus, longitudinaltranslation of inner tube (34) relative to outer sheath (32) causesclamp arm (44) to pivot about pin (33) toward and away from ultrasonicblade (42) to thereby clamp tissue between clamp pad (46) and ultrasonicblade (42) to transect and/or seal the tissue. In particular, as seen inthe transition from FIG. 3A to FIG. 3B, proximal longitudinaltranslation of inner tube (34) relative to outer sheath (32) and handleassembly (20) causes clamp arm (44) to pivot toward ultrasonic blade(42); and distal longitudinal translation of inner tube (34) relative toouter sheath (32) and handle assembly (20) causes clamp arm (44) topivot away from ultrasonic blade (42). It should therefore be understoodthat pivoting of trigger (28) toward pistol grip (24) will cause clamparm (44) to pivot toward ultrasonic blade (42); and that pivoting oftrigger (28) away from pistol grip (24) will cause clamp arm (44) topivot away from ultrasonic blade (42).

An ultrasonic transducer assembly (12) extends proximally from body (22)of handle assembly (20). Transducer assembly (12) is coupled with agenerator (16) via a cable (14). Transducer assembly (12) receiveselectrical power from generator (16) and converts that power intoultrasonic vibrations through piezoelectric principles. Generator (16)may include a power source and control module that is configured toprovide a power profile to transducer assembly (12) that is particularlysuited for the generation of ultrasonic vibrations through transducerassembly (12). By way of example only, generator (16) may comprise a GEN300 sold by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. In additionor in the alternative, generator (16) may be constructed in accordancewith at least some of the teachings of U.S. Pub. No. 2011/0087212,entitled “Surgical Generator for Ultrasonic and ElectrosurgicalDevices,” published Apr. 14, 2011, now U.S. Pat. No. 8,986,302, issuedon Mar. 24, 2015, the disclosure of which is incorporated by referenceherein. It should also be understood that at least some of thefunctionality of generator (16) may be integrated into handle assembly(20), and that handle assembly (20) may even include a battery or otheron-board power source such that cable (14) is omitted. Still othersuitable forms that generator (16) may take, as well as various featuresand operabilities that generator (16) may provide, will be apparent tothose of ordinary skill in the art in view of the teachings herein.

Ultrasonic vibrations that are generated by transducer assembly (12) arecommunicated along an acoustic waveguide (38), which extends throughshaft assembly (30) to reach ultrasonic blade (42). Waveguide (38) issecured within shaft assembly (30) via a pin (not shown), which passesthrough waveguide (38) and shaft assembly (30). The pin is located at aposition along the length of waveguide (38) corresponding to a nodeassociated with resonant ultrasonic vibrations communicated throughwaveguide (38). As noted above, when ultrasonic blade (42) is in anactivated state (i.e., vibrating ultrasonically), ultrasonic blade (42)is operable to effectively cut through and seal tissue, particularlywhen the tissue is being clamped between clamp pad (46) and ultrasonicblade (42). It should be understood that waveguide (38) may beconfigured to amplify mechanical vibrations transmitted throughwaveguide (38). Furthermore, waveguide (38) may include featuresoperable to control the gain of the longitudinal vibrations alongwaveguide (38) and/or features to tune waveguide (38) to the resonantfrequency of the system.

In the present example, the distal end of ultrasonic blade (42) islocated at a position corresponding to an anti-node associated withresonant ultrasonic vibrations communicated through waveguide (38), inorder to tune the acoustic assembly to a preferred resonant frequencyf_(o) when the acoustic assembly is not loaded by tissue. Whentransducer assembly (12) is energized, the distal end of ultrasonicblade (42) is configured to move longitudinally in the range of, forexample, approximately 10 to 500 microns peak-to-peak, and in someinstances in the range of about 20 to about 200 microns at apredetermined vibratory frequency f_(o) of, for example, 55.5 kHz. Whentransducer assembly (12) of the present example is activated, thesemechanical oscillations are transmitted through the waveguide to reachultrasonic blade (102), thereby providing oscillation of ultrasonicblade (102) at the resonant ultrasonic frequency. Thus, when tissue issecured between ultrasonic blade (42) and clamp pad (46), the ultrasonicoscillation of ultrasonic blade (42) may simultaneously sever the tissueand denature the proteins in adjacent tissue cells, thereby providing acoagulative effect with relatively little thermal spread. In someversions, generator (16) drives transducer assembly (12) dynamically,such that the ultrasonic vibrations at blade (42) vary. Such variationmay be provided as a function of time, as a function of sensedconditions at the surgical site (e.g., tissue thickness, tissueimpedance, etc.), and/or based on other factors or combinations offactors. By way of example only, generator (16) may adjust the amplitudeand/or duty cycle associated with the ultrasonic vibrations based onsensed tissue impedance, in order to optimize performance. It shouldalso be understood that, in some versions, an electrical current mayalso be provided through ultrasonic blade (42) and/or clamp pad (46) toalso seal the tissue.

An operator may activate buttons (26) to selectively activate transducerassembly (12) to thereby activate ultrasonic blade (42). In the presentexample, two buttons (26) are provided—one for activating ultrasonicblade (42) at a low power and another for activating ultrasonic blade(42) at a high power. However, it should be understood that any othersuitable number of buttons and/or otherwise selectable power levels maybe provided. For instance, a foot pedal may be provided to selectivelyactivate transducer assembly (12). Buttons (26) of the present exampleare positioned such that an operator may readily fully operateinstrument (10) with a single hand. For instance, the operator mayposition their thumb about pistol grip (24), position their middle,ring, and/or little finger about trigger (28), and manipulate buttons(26) using their index finger. Of course, any other suitable techniquesmay be used to grip and operate instrument (10); and buttons (26) may belocated at any other suitable positions.

The foregoing components and operabilities of instrument (10) are merelyillustrative. Instrument (10) may be configured in numerous other waysas will be apparent to those of ordinary skill in the art in view of theteachings herein. By way of example only, at least part of instrument(10) may be constructed and/or operable in accordance with at least someof the teachings of any of the following, the disclosures of which areall incorporated by reference herein: U.S. Pat. Nos. 5,322,055;5,873,873; 5,980,510; 6,325,811; 6,783,524; U.S. Pub. No. 2006/0079874;U.S. Pub. No. 2007/0191713; U.S. Pub. No. 2007/0282333; U.S. Pub. No.2008/0200940; U.S. Pub. No. 2010/0069940, now U.S. Pat. No. 9,023,071,issued on May 5, 2015; U.S. Pub. No. 2011/0015660, now U.S. Pat. No.8,461,744, issued on Jun. 11, 2013; U.S. Pub. No. 2012/0112687, now U.S.Pat. No. 9,381,058, issued on Jul. 5, 2016; U.S. Pub. No. 2012/0116265;U.S. patent application Ser. No. 13/538,588, now U.S. Pat. No.9,393,037, issued on Jul. 19, 2016; and/or U.S. patent application Ser.No. 13/657,553, now U.S. Pat. No. 9,095,367, issued on Aug. 4, 2015.Additional merely illustrative variations for instrument (10) will bedescribed in greater detail below. It should be understood that thebelow described variations may be readily applied to instrument (10)described above and any of the instruments referred to in any of thereferences that are cited herein, among others.

B. Exemplary Ultrasonic Surgical Instrument for Open Surgical Procedures

FIG. 4 illustrates an exemplary ultrasonic surgical instrument (100)that is configured to be used in open surgical procedures. Instrument(100) of this example comprises a handle assembly (120), a shaftassembly (130), and an end effector (140). Handle assembly (120)comprises a body (122) including a finger grip ring (124) and a pair ofbuttons (126). Instrument (100) also includes a clamp arm assembly (150)that is pivotable toward and away from body (122). Clamp arm assembly(150) includes a shank (152) with a thumb grip ring (154). Thumb gripring (154) and finger grip ring (124) together provide a scissor griptype of configuration. It should be understood, however, that variousother suitable configurations may be used, including but not limited toa pistol grip configuration.

Shaft assembly (130) comprises an outer sheath (132) extending distallyfrom body (122). A cap (134) is secured to the distal end of sheath(132). As best seen in FIGS. 5-6B, end effector (140) comprises anultrasonic blade (142) and a clamp arm (144). Ultrasonic blade (142)extends distally from cap (134). Clamp arm (144) is an integral featureof clamp arm assembly (150). Clamp arm (144) includes a clamp pad (146)facing ultrasonic blade (142). Clamp arm assembly (150) is pivotallycoupled with outer sheath (132) via a pin (156). Clamp arm (144) ispositioned distal to pin (156); while shank (152) and thumb grip ring(154) are positioned proximal to pin (156). Thus, as shown in FIGS.6A-6B, clamp arm (144) is pivotable toward and away from ultrasonicblade (142) based on pivoting of thumb grip ring (154) toward and awayfrom body (122) of handle assembly (120). It should therefore beunderstood that an operator may squeeze thumb grip ring (154) towardbody (122) to thereby clamp tissue between clamp pad (146) andultrasonic blade (142) to transect and/or seal the tissue. In someversions, one or more resilient members are used to bias clamp arm (144)to the open position shown in FIG. 6A. By way of example only, such aresilient member may comprise a leaf spring, a torsion spring, and/orany other suitable kind of resilient member.

Referring back to FIG. 4, an ultrasonic transducer assembly (112)extends proximally from body (122) of handle assembly (120). Transducerassembly (112) is coupled with a generator (116) via a cable (114).Transducer assembly (112) receives electrical power from generator (116)and converts that power into ultrasonic vibrations through piezoelectricprinciples. Generator (116) may include a power source and controlmodule that is configured to provide a power profile to transducerassembly (112) that is particularly suited for the generation ofultrasonic vibrations through transducer assembly (112). By way ofexample only, generator (116) may comprise a GEN 300 sold by EthiconEndo-Surgery, Inc. of Cincinnati, Ohio. In addition or in thealternative, generator (116) may be constructed in accordance with atleast some of the teachings of U.S. Pub. No. 2011/0087212, entitled“Surgical Generator for Ultrasonic and Electrosurgical Devices,”published Apr. 14, 2011, now U.S. Pat. No. 8,986,302, issued on Mar. 24,2015, the disclosure of which is incorporated by reference herein. Itshould also be understood that at least some of the functionality ofgenerator (116) may be integrated into handle assembly (120), and thathandle assembly (120) may even include a battery or other on-board powersource such that cable (114) is omitted. Still other suitable forms thatgenerator (116) may take, as well as various features and operabilitiesthat generator (116) may provide, will be apparent to those of ordinaryskill in the art in view of the teachings herein.

Ultrasonic vibrations that are generated by transducer assembly (112)are communicated along an acoustic waveguide (138), which extendsthrough shaft assembly (130) to reach ultrasonic blade (142). Waveguide(138) is secured within shaft assembly (130) via a pin (not shown),which passes through waveguide (138) and shaft assembly (130). This pinis located at a position along the length of waveguide (138)corresponding to a node associated with resonant ultrasonic vibrationscommunicated through waveguide (138). As noted above, when ultrasonicblade (142) is in an activated state (i.e., vibrating ultrasonically),ultrasonic blade (142) is operable to effectively cut through and sealtissue, particularly when the tissue is being clamped between clamp pad(146) and ultrasonic blade (142). It should be understood that waveguide(138) may be configured to amplify mechanical vibrations transmittedthrough waveguide (138). Furthermore, waveguide (138) may includefeatures operable to control the gain of the longitudinal vibrationsalong waveguide (138) and/or features to tune waveguide (138) to theresonant frequency of the system.

In the present example, the distal end of ultrasonic blade (142) islocated at a position corresponding to an anti-node associated withresonant ultrasonic vibrations communicated through waveguide (138), inorder to tune the acoustic assembly to a preferred resonant frequencyf_(o) when the acoustic assembly is not loaded by tissue. Whentransducer assembly (112) is energized, the distal end of ultrasonicblade (142) is configured to move longitudinally in the range of, forexample, approximately 10 to 500 microns peak-to-peak, and in someinstances in the range of about 20 to about 200 microns at apredetermined vibratory frequency f_(o) of, for example, 55.5 kHz. Whentransducer assembly (112) of the present example is activated, thesemechanical oscillations are transmitted through the waveguide to reachultrasonic blade (102), thereby providing oscillation of ultrasonicblade (102) at the resonant ultrasonic frequency. Thus, when tissue issecured between ultrasonic blade (142) and clamp pad (46), theultrasonic oscillation of ultrasonic blade (142) may simultaneouslysever the tissue and denature the proteins in adjacent tissue cells,thereby providing a coagulative effect with relatively little thermalspread. In some versions, an electrical current may also be providedthrough ultrasonic blade (142) and/or clamp pad (146) to also seal thetissue.

An operator may activate buttons (126) to selectively activatetransducer assembly (112) to thereby activate ultrasonic blade (142). Inthe present example, two buttons (126) are provided—one for activatingultrasonic blade (142) at a low power and another for activatingultrasonic blade (142) at a high power. However, it should be understoodthat any other suitable number of buttons and/or otherwise selectablepower levels may be provided. For instance, a foot pedal may be providedto selectively activate transducer assembly (112). Buttons (126) of thepresent example are positioned such that an operator may readily fullyoperate instrument (100) with a single hand. For instance, the operatormay position their thumb in thumb grip ring (154), position their ringfinger in finger grip ring (124), position their middle finger aboutbody (122), and manipulate buttons (126) using their index finger. Ofcourse, any other suitable techniques may be used to grip and operateinstrument (100); and buttons (126) may be located at any other suitablepositions.

The foregoing components and operabilities of instrument (100) aremerely illustrative. Instrument (100) may be configured in numerousother ways as will be apparent to those of ordinary skill in the art inview of the teachings herein. By way of example only, at least part ofinstrument (100) may be constructed and/or operable in accordance withat least some of the teachings of any of the following, the disclosuresof which are all incorporated by reference herein: U.S. Pat. Nos.5,322,055; 5,873,873; 5,980,510; 6,325,811; 6,783,524; U.S. Pub. No.2006/0079874; U.S. Pub. No. 2007/0191713; U.S. Pub. No. 2007/0282333;U.S. Pub. No. 2008/0200940; U.S. Pub. No. 2010/0069940, now U.S. Pat.No. 9,023,071, issued on May 5, 2015; U.S. Pub. No. 2011/0015660, nowU.S. Pat. No. 8,461,744, issued on Jun. 11, 2013; U.S. Pub. No.2012/0112687, now U.S. Pat. No. 9,381,058, issued on Jul. 5, 2016; U.S.Pub. No. 2012/0116265; U.S. patent application Ser. No. 13/538,588, nowU.S. Pat. No. 9,393,037, issued on Jul. 19, 2016; U.S. patentapplication Ser. No. 13/657,553, now U.S. Pat. No. 9,095,367, issued onAug. 4, 2015; and/or U.S. patent application Ser. No. 14/031,665,published as U.S. Pub. No. 2015/0080925 on Mar. 19, 2015. Additionalmerely illustrative variations for instrument (100) will be described ingreater detail below. It should be understood that the below describedvariations may be readily applied to instrument (100) described aboveand any of the instruments referred to in any of the references that arecited herein, among others.

II. Exemplary Ultrasonic Surgical Instruments with Ultrasonic BladeRotation Mechanisms

Clamp arms (44, 144) of instruments (10, 100) discussed above movepivotally toward and away from ultrasonic blades (42, 142), along asingle plane. In some instances, this pivotal movement of clamp arm (44,144) may not allow for an adequate distribution of force to be appliedto the tissue clamped between clamp arm (44, 144) and ultrasonic blade(42, 142). This inadequate distribution of force may allow for “tags” oftissue (e.g., flattened but uncut regions of tissue) to be formed,particularly at a distal end and/or proximal end of end effector (40,140). Thus, in some versions of instrument (10, 100) it may be desirableto provide a mechanism that provides improved distribution of force tobe applied to the tissue clamped between clamp arm (44, 144) andultrasonic blade (42, 142) to reduce the occurrence of tissue tagsand/or to provide severing of tissue tags. For instance, one mechanismmay selectively rotate ultrasonic blade (42, 142) about a longitudinalaxis (e.g., the longitudinal axis of waveguide (38, 138)) as clamp arm(44, 144) moves toward and/or away from ultrasonic blade (42, 142) totake advantage of a curved profile of ultrasonic blade (42, 142), tothereby apply an adequate distribution of force to the tissue clampedbetween clamp arm (44, 144) and ultrasonic blade (42, 142) through arolling contact effect.

In versions where ultrasonic blade (42, 142) has a curved configuration,this rolling contact may provide a contact interface between ultrasonicblade (42, 142) and clamp pad (46, 146) that is localized along aportion of the length of blade (42, 142), with that localized contactinterface area traveling along the length of ultrasonic blade (42, 142)(e.g., from the distal end of ultrasonic blade (42, 142) to the proximalend of ultrasonic blade (42, 142) or from the proximal end of ultrasonicblade (42, 142) to the distal end of ultrasonic blade (42, 142), etc.)as ultrasonic blade (42, 142) rotates relative to clamp pad (46, 146).This rolling contact may ensure that pressure is applied to tissue alongthe entire length of tissue captured between ultrasonic blade (42, 142)and clamp pad (46, 146). This rolling contact may also reduce wear onclamp pad (46, 146) and thus increase its useful life. It should beunderstood that the rolling contact described herein may occur directlybetween ultrasonic blade (42, 142) and clamp pad (46, 146) (e.g., inregions where no tissue is captured between ultrasonic blade (42, 142)and clamp pad (146)) or indirectly between ultrasonic blade (42, 142)and clamp pad (46, 146) (e.g., in regions where tissue is capturedbetween ultrasonic blade (42, 142) and clamp pad (46, 146)).

In addition to or as an alternative to preventing or otherwiseaddressing tissue tags, the examples described herein may also providevarying pressure profiles on tissue clamped between ultrasonic blade(42, 142) and clamp pad (46, 146). For instance, when end effector (40,140) is used to apply a rolling contact pressure on a vessel that isapproximately 7 mm in thickness, ultrasonic blade (42, 142) and clamppad (46, 146) may initially provide a low pressure to seal the tissue;followed by a high pressure to cut the tissue. As yet another merelyillustrative example, rolling contact applied through ultrasonic blade(42, 142) and clamp pad (46, 146) may squeeze and roll a vessel tobetter direct apposition of the collagen rich adventia layers of thetissue of the vessel.

Various illustrative examples of an instrument that includes anultrasonic blade (42, 142) rotation mechanism will be described ingreater detail below, while other examples will be apparent to those ofordinary skill in the art in view of the teachings herein. It should beunderstood that the below examples may be viewed as variations ofinstruments (10, 100), such that various teachings below may be readilycombined with various teachings above as will be apparent to those ofordinary skill in the art. It should also be understood that ultrasonicblade (42, 142) may be activated ultrasonically while ultrasonic blade(42, 142) is being rotated about the longitudinal axis.

A. First Exemplary Ultrasonic Blade Rotation Mechanism

FIGS. 7A and 7B show an exemplary ultrasonic blade rotation mechanism(200), which may be readily incorporated into instrument (100). Rotationmechanism (200) of the present example comprises a pinion gear (202) anda rack member (204). Gear (202) is secured to exterior surface ofwaveguide (138), such that gear (202) and waveguide (138) rotateconcomitantly. In the present example, gear (202) is secured towaveguide (138) at a node associated with resonant ultrasonic vibrationscommunicated through waveguide (138) and ultrasonic blade (142).Alternatively, gear (202) may be secured to waveguide (138) away from anode associated with resonant ultrasonic vibrations communicated throughwaveguide (138) and ultrasonic blade (142). Waveguide (138) of thepresent example is rotatably disposed within shaft assembly (130) suchthat waveguide (138) is rotatable relative to shaft assembly (130). Gear(202) comprises a plurality of teeth (203) arranged in an angularpattern and extending radially and longitudinally from an exteriorsurface of gear (202).

Rack member (204) extends downwardly from a bottom surface of shank(152) of clamp arm assembly (150) and passes through a passageway (206)that passes through shaft assembly (130). Passageway (206) passesthrough shaft assembly (130) at a position adjacent to teeth (203) ofgear (202). A portion of rack member (204) near shank (152) comprises aplurality of teeth (205). As will be understood from the discussionbelow, teeth (205) of rack member (204) are configured to engage teeth(203) of gear (202) to thereby cause rotation of gear (202).

As shown in FIG. 7A, with clamp arm assembly (150) in an open position,teeth (205) of rack member (204) are not engaged with teeth (203) ofgear (202). Thus, that as clamp arm assembly (150) is moved through afirst range of motion toward a closed position, movement of rack member(204) through passageway (206) will not cause rotation of gear (202).However, teeth (205) eventually engage teeth (203) as clamp arm assembly(150) continues to pivot toward the closed position. In particular,teeth (205) of rack member (204) mesh with teeth (203) of gear (202) asclamp arm assembly (150) continues to pivot through a second range ofmotion toward the closed position as shown in FIG. 7B. This engagementof teeth (203) with teeth (205) causes rotation of gear (202), waveguide(138), and ultrasonic blade (142) as clamp arm assembly (150) pivotsthrough the second range of motion.

As can be seen in the transition from FIG. 7A to FIG. 7B, the rotationof ultrasonic blade (142) provides a rolling engagement betweenultrasonic blade (142) and clamp pad (146) as clamp arm assembly (150)pivots through the second range of motion, due to the curvedconfiguration of ultrasonic blade (142). In some versions, only thedistal end of ultrasonic blade (142) contacts clamp pad (146) at thebeginning of the second range of motion; then the area of localizedcontact between ultrasonic blade (142) and clamp pad (146) translatesproximally along the length of blade (142) as clamp arm assembly (150)travels through the remainder of the second range of motion. As yetanother merely illustrative example, the full length of ultrasonic blade(142) may initially contact clamp pad (146) at the beginning of thesecond range of motion; then an area of localized contact betweenultrasonic blade (142) and clamp pad (146) translates proximally fromthe distal end of blade (142) to the proximal end of blade (142) (ordistally from the proximal end of blade (142) to the distal end of blade(142)) as clamp arm assembly (150) travels through the remainder of thesecond range of motion. In any of the foregoing examples, the rollingengagement between a localized region of the length of ultrasonic blade(142) and clamp pad (146) may either prevent tissue tags from beingformed or may sever tissue tags, promoting a clean, full cut by endeffector (140).

In the present example, the location of teeth (205) proximal to shank(152) causes waveguide (138) to only rotate as clamp arm assembly (150)reaches a substantially closed position, such that ultrasonic blade(142) will only rotate after tissue has been clamped between clamp arm(144) and ultrasonic blade (142). Alternatively, teeth (205) may belocated anywhere along rack member (204) to thereby cause rotation ofwaveguide (138) and ultrasonic blade (142) at any point between the openposition and the closed position of clamp arm assembly (150). It shouldfurther be appreciated that, as clamp arm assembly (150) is moved fromthe closed position back toward the open position, teeth (205) of rackmember (204) engages teeth (203) of gear (202) to thereby rotatewaveguide (202) and ultrasonic blade (142) back toward their originalorientation.

Although rotation mechanism (200) is discussed as being used withinstrument (100) in the present example, it should be understood thatrotation mechanism (200) may be readily incorporated into instrument(10). For instance, rack member (204) may be secured to trigger (28) andconfigured to cause rotation of waveguide (38) as trigger (28) is movedtoward and away from pistol grip (24). Other suitable variations ofrotation mechanism (200) will be apparent to those of ordinary skill inthe art in view of the teachings herein.

B. Second Exemplary Ultrasonic Blade Rotation Mechanism

FIGS. 8 and 9 show an exemplary alternative ultrasonic blade rotationmechanism (220) that may be readily incorporated into instrument (100).Rotation mechanism (220) of this example comprises a rotation knob(222). Waveguide (138) of the present example is rotatably disposedwithin shaft assembly (130) such that waveguide (138) is rotatablerelative to shaft assembly (130). Rotation knob (222) is secured towaveguide (138) via pin (133) such that rotation of rotation knob (222)causes concurrent rotation of waveguide (138). It should therefore beunderstood that before, while, and/or after clamp arm assembly (150) ismoved toward the closed position, a user may manually rotate waveguide(138) and ultrasonic blade (142) via rotation knob (222).

As shown in FIG. 9, a proximal surface of rotation knob (222) comprisesa series of detent recesses (224, 226, 228). Detent recesses (224, 226,228) are configured to align with a projection (not shown) of shaftassembly (130) to thereby selectively lock rotation knob (222),waveguide (138), and ultrasonic blade (142) in a particular rotationalposition. The projection may be resiliently biased or otherwisedeformable. In addition to providing selective locking of the angularposition of rotation knob (222), waveguide (138), and ultrasonic blade(142) in a particular rotational position relative to shaft assembly(130), detent recesses (224, 226, 228) and the projection may alsoprovide audible and/or tactile feedback to the operator indicating thata particular angular orientation has been reached. For instance, theoperator may hear and/or feel the projection pop into a recess (224,226, 228).

Detent recess (226) of rotation knob (222) represents a rotationalposition wherein ultrasonic blade (142) is oriented substantiallyparallel to clamp pad (146). Detent recess (224) of rotation knob (222)represents a rotational position wherein ultrasonic blade (138) has beenrotated counter-clockwise approximately 45° such that a distal tip ofultrasonic blade (142) is angled toward clamp pad (146), with theproximal portion of ultrasonic blade (142) being angled away from clamppad (146). In other words, detent recess (224) is associated with atip-loaded configuration for end effector (140). Such a tip-loadedconfiguration may be used to prevent tissue tags that might otherwise beleft by end effector (140) if end effector (140) were actuated withultrasonic blade (142) oriented substantially parallel to clamp pad(146). In addition or in the alternative, such a tip-loadedconfiguration may promote the use of the distal end of end effector(140) to make smaller “nibble” types of incisions in tissue.

Detent recess (228) of rotation knob (222) represents a rotationalposition wherein ultrasonic blade (138) has been rotated clockwiseapproximately 45° such that a distal tip of ultrasonic blade (142) isangled away from clamp pad (146), with the proximal portion ofultrasonic blade (142) being angled toward clamp pad (146). In otherwords, detent recess (228) is associated with a proximal-loadedconfiguration for end effector (140). Such a proximal-loadedconfiguration may be used to prevent tissue tags that might otherwise beleft by end effector (140) if end effector (140) were actuated withultrasonic blade (142) oriented substantially parallel to clamp pad(146). In some instances, the operator rotates knob (222) to selectwhich detent recess (224, 226, 228) to engage, and then actuates endeffector (140) to compress, cut, and coagulate tissue clamped betweenclamp pad (146) and ultrasonic blade (142) at the corresponding angularorientation relative to shaft assembly (130). In some other versions,the operator rotates knob (222) to cycle through or between two or moredetent recess (224, 226, 228) while tissue is clamped in end effector(140), such as to provide a rolling engagement between ultrasonic blade(142) and clamp pad (146) as described above. Other suitable ways inwhich rotation mechanism (200) may be operated will be apparent to thoseof ordinary skill in the art in view of the teachings herein.

While detent recesses (224, 226, 228) of the present example areangularly arranged approximately 45° from one another, it should beunderstood that detents (224, 226, 228) may be arranged at any othersuitable angular distance. Moreover, any other suitable number ofdetents may be provided. While rotation mechanism (220) is discussed asbeing used with instrument (100) in the present example, it should beunderstood that rotation mechanism (220) may readily incorporated intoinstrument (10).

C. Third Exemplary Ultrasonic Blade Rotation Mechanism

FIGS. 10-11D show another exemplary alternative ultrasonic bladerotation mechanism (240) that may be readily incorporated intoinstrument (100). Rotation mechanism (240) of the present examplecomprises a motor (242) secured to a proximal end of waveguide (138).Waveguide (138) of the present example is rotatably disposed withinshaft assembly (130) such that waveguide (138) is rotatable relative toshaft assembly (130). Motor (242) is configured to rotate waveguide(138) and ultrasonic blade (142) within shaft assembly (130). Motor(242) is operable to turn in both clockwise and counter clockwisedirections. Motor (242) may comprise a hub motor, a hollow shaft motor,a hollow shaft pancake motor, or any other type of motor appropriate tocause rotation of waveguide (138). As will be described in greaterdetail below, motor (242) of the present example is configured to rotatewaveguide (138) and ultrasonic blade (142) in response to pivotalmovement of clamp arm assembly (150) between the open position and theclosed position. In some instances, one or more reed switches, halleffect sensors, and/or other kind(s) of position sensitive sensor(s)is/are used to sense pivotal position of clamp arm assembly (150)relative to shaft assembly (130). Such sensor(s) may thus be used toactivate motor (242) once clamp arm assembly (150) reaches a particularposition relative to shaft assembly (130). Other suitable ways in whichmotor (242) may be activated will be apparent to those of ordinary skillin the art in view of the teachings herein.

FIGS. 11A-11D show the rotation of waveguide (138) and ultrasonic blade(142) via motor (242) as clamp arm assembly (150) moves toward theclosed position. As shown in FIG. 11A, in the open position, the distaltip of ultrasonic blade (142) is angled downwardly. As clamp armassembly (150) is moved toward the closed position through a first rangeof motion, clamp pad (146) of clamp arm (144) contacts the downwardlyangled distal tip of ultrasonic blade (142) as shown in FIG. 11B. Onceclamp arm assembly (150) reaches this position, motor (242) rotateswaveguide (138) and ultrasonic blade (142) until ultrasonic blade (142)is substantially parallel with clamp pad (146), and clamp arm assembly(150) is pivoted further through a second range of motion to bring clamppad (146) in full apposition with ultrasonic blade (142), as shown inFIG. 11C. This rotation of ultrasonic blade (142) causes the forceapplied by clamp arm (144) to transition along the curved profile ofultrasonic blade (142) from the distal tip of ultrasonic blade (142)proximally toward waveguide (138), along the full length of ultrasonicblade (142). With clamp arm assembly (150) remaining in the closedposition, motor (242) continues to rotate waveguide (138) and ultrasonicblade (142) until the distal tip of ultrasonic blade (142) is angledupwardly as shown in FIG. 11D. This rotation of ultrasonic blade (142)causes the force applied by clamp arm (144) to transition furtherproximally along the curved profile of ultrasonic blade (142) towardwaveguide (138). Thus, the sequence shown in FIGS. 11A-11D show arolling contact between ultrasonic blade (142) and clamp pad (146) thatbegins at the distal end of ultrasonic blade (142) and transitionsproximally to the proximal end of ultrasonic blade (142).

In some other versions, motor (242) rotates in the opposite directionsuch that the rolling contact between ultrasonic blade (142) and clamppad (146) that begins at the proximal end of ultrasonic blade (142) andtransitions distally to the distal end of ultrasonic blade (142). Itshould also be understood that motor (242) may be operated to provide arocking motion through ultrasonic blade (142) such that motor (242)drives blade in a reciprocating angular motion of less than 360°. Othersuitable ways in which motor (242) may be used to controllably vary therelationship between ultrasonic blade (142) and clamp pad (146) will beapparent to those of ordinary skill in the art in view of the teachingsherein. While rotation mechanism (240) is discussed as being used withinstrument (100) in the present example, it should be understood thatrotation mechanism (240) may also be readily incorporated intoinstrument (10).

D. Fourth Exemplary Ultrasonic Blade Rotation Mechanism

FIGS. 12A-13B show yet another exemplary alternative ultrasonic bladerotation mechanism (260) that may be readily incorporated intoinstrument (100). Rotation mechanism (260) of the present examplecomprises an elongate member (262) extending downwardly from shank(152). Waveguide (138) of the present example is rotatably disposedwithin shaft assembly (130) such that waveguide (138) is rotatablerelative to shaft assembly (130). Elongate member (262) is configured tomove within a passageway (264) in shaft assembly (130) as clamp armassembly (150) is moved between the open position and the closedposition. As will be described in greater detail below, movement ofelongate member (262) within passageway (264) causes rotation ofwaveguide (138) and ultrasonic blade (142) as clamp arm assembly (150)approaches the closed position.

As shown in FIGS. 13A-13B, the interior of outer sheath (132) of thepresent example presents a first recess (132A) and a second recess(132B). Pin (133) extends transversely through waveguide (138) such thata first end of pin (133) is disposed within first recess (132A) and asecond end of pin (133) is disposed within second recess (132B). Pin(133) is located at a position along the length of waveguide (138)corresponding to a node associated with resonant ultrasonic vibrationscommunicated through waveguide (138). FIG. 13A shows waveguide (138) aposition wherein ultrasonic blade (142) is substantially parallel toclamp pad (142). In this position, the first end of pin (133) rests upona spring (266) positioned within first recess (132A). Also in thisposition, the second end of pin (133) rests upon a bottom surface ofsecond recess (132B). As clamp arm assembly (150) is moved toward into asubstantially closed position, as shown n FIG. 13A, a bottom tip ofelongate member (262) contacts the first end of pin (133). As clamp armassembly (150) is moved into the closed position the bottom tip ofelongate member (262) drives the first end of pin (133) downwardly tothereby rotate waveguide (138) counter-clockwise about the longitudinalaxis of waveguide (138) as shown in FIG. 13B.

In the present example, ultrasonic blade (142) is configured to reach astate of full apposition with clamp pad (146) along the length ofultrasonic blade (142) and clamp pad (146) once clamp arm assembly (150)reaches the position shown in FIG. 13A. As clamp arm assembly (150) isdriven further toward shaft assembly (130) to rotate waveguide (138) asshown in FIG. 13B, the curved configuration of ultrasonic blade (142)and the rotation of ultrasonic blade (142) together provide a distallyadvancing rolling engagement, such that an increased amount ofcompression force is applied between the distal end of ultrasonic blade(142) and clamp pad (146). Thus, the compression force between thedistal end of ultrasonic blade (142) and clamp pad (146) increasesduring the transition from the configuration shown in FIG. 13A to theconfiguration shown in FIG. 13B. This increase in distal compression mayprevent formation of a tissue tag or cut a tissue tag at the distal endof end effector (140). As soon as the operator relaxes their grip ongrip rings (124, 154), allowing clamp arm assembly (150) to pivot backaway from shaft assembly (130), the resilient bias of spring (266) mayurge pin (133) back to the position shown in FIG. 13A.

While rotation mechanism (260) is discussed as being incorporated intoinstrument (100) in the present example, it should be understood thatrotation mechanism (260) may be readily incorporated into instrument(10).

E. Fifth Exemplary Ultrasonic Blade Rotation Mechanism

FIGS. 14-15C show yet another exemplary alternative ultrasonic bladerotation mechanism (280) that may be readily incorporated intoinstrument (100). Rotation mechanism (280) of the present examplecomprises an elastomeric bushing (282) secured to a distal end ofwaveguide (138), just proximal to ultrasonic blade (142). Waveguide(138) of the present example is rotatably disposed within shaft assembly(130) such that waveguide (138) is rotatable relative to shaft assembly(130) and is biased toward a counter-clockwise rotational position, asshown in FIG. 15A, such that the distal tip of ultrasonic blade (142) isangled downwardly to first contact clamp pad (146) as clamp arm assembly(150) is pivoted toward shaft assembly (130). As best seen in FIG. 14,bushing (282) is secured to an exterior of waveguide (138). As shown inFIGS. 15A-15C, a bottom of bushing (282) presents a flat surface (283).Flat surface (283) is formed at an angle that is oblique relative to abottom surface of ultrasonic blade (142) and relative to an opposingsurface of clamp pad (146). As will be described in greater detailbelow, flat surface (283) of bushing (282) is configured to bear againstclamp pad (146) of clamp arm (144) as clamp arm assembly (150) ispivoted further toward clamp arm assembly (130), thereby causingwaveguide (138) and ultrasonic blade (142) to rotate clockwise such thatultrasonic blade (142) reaches a state of full apposition with clamp pad(146); and in some versions, ultimately to a position where the distaltip of ultrasonic blade (142) is angled upwardly and away from clamp pad(146).

FIGS. 15A-15C show the rotation of waveguide (138) and ultrasonic blade(142) as clamp arm assembly (150) is pivoted toward shaft assembly (130)to provide varying degrees of closure. As previously discussed,waveguide (138) is biased toward a counter-clockwise rotationalposition, as shown in FIG. 15A, such that when clamp arm assembly (150)in the first closed position, the distal tip of ultrasonic blade (142)is angled downwardly and in contact with clamp pad (146). As clamp armassembly (150) is moved toward a further closed position, a corner offlat surface (283) contacts clamp pad (146). This contact begins torotate waveguide (138) clockwise as clamp arm assembly (150) is movedfurther toward the closed position as shown in FIG. 15B. At this stagethe full length of ultrasonic blade (142) may or may not reach a stateof apposition with clamp pad (146). As clamp arm assembly (150) ispivoted further toward shaft assembly (130), substantially all of flatsurface (283) contacts clamp pad (146) to further rotate waveguide (138)and ultrasonic blade (142) clockwise such that the distal tip ofultrasonic blade (142) is angled upwardly and away from clamp pad (146)as shown in FIG. 15C. Thus, the sequence shown in FIGS. 15A-15C providesa rolling contact beginning at the distal end of ultrasonic blade (142)and travelling proximally to the proximal end of ultrasonic blade (142).

In some versions, a resilient member such as a torsion spring,elastomeric bushing, and/or other feature is used to rotationally biasultrasonic blade (142) to the orientation shown in FIG. 15A. Thus, whenthe operator relaxes their grip on grip rings (124, 154), the bias ofthe resilient member rotates ultrasonic blade (142) back from theorientation shown in FIG. 15C to the orientation shown in FIG. 15A.Alternatively, the resilience of bushing (282) itself may suffice torotate ultrasonic blade (142) back from the orientation shown in FIG.15C to the orientation shown in FIG. 15A when the operator relaxes theirgrip on grip rings (124, 154).

Also in some versions, a detent feature is included to provide audibleand/or tactile feedback indicating when end effector (140) istransitioning from the state shown in FIG. 15A to the state shown inFIG. 15B; and/or when end effector (140) is transitioning from the stateshown in FIG. 15B to the state shown in FIG. 15C. It should also beunderstood that such detent features may be provided in various otherexamples described herein, including but not limited to the otherexamples described herein providing a rolling contact between anultrasonic blade (142) and clamp pad (146).

While rotation mechanism (260) is discussed as being incorporated intoinstrument (100) in the present example, it should be understood thatrotation mechanism (260) may be readily incorporated into instrument(10). For instance, bushing (282) may be secured to a distal end ofwaveguide (38) of instrument (10) such that bushing (282) bears againstclamp arm (44) to thereby cause rotation of waveguide (38).

F. Sixth Exemplary Ultrasonic Blade Rotation Mechanism

FIGS. 16-17B show yet another exemplary alternative ultrasonic bladerotation mechanism (300) that may be readily incorporated intoinstrument (10). Rotation mechanism (300) of the present examplecomprises an exemplary alternative inner tube (302). Inner tube (302) ofthe present example is configured to operate substantially similar toinner tube (34) discussed above except for the differences discussedbelow. In particular, longitudinal translation of inner tube (302)relative to outer sheath (32) causes actuation of clamp arm (44) at endeffector (40). Waveguide (38) of the present example is rotatablydisposed within inner tube (302) such that waveguide (38) is rotatablerelative to shaft assembly (30). Inner tube (302) comprises a pair ofcamming channels (304, 306) formed in diametrically opposite sides ofinner tube (302). While inner tube (302) is translatable relative toouter sheath (32) in this example, inner tube (302) does not rotaterelative to outer sheath (32) in this example.

As discussed above with reference to instrument (10), waveguide (38) issecured within shaft assembly (30) via a pin (31), which passestransversely through waveguide (38). Pin (31) is located at a positionalong the length of waveguide (38) corresponding to a node associatedwith resonant ultrasonic vibrations communicated through waveguide (38).As will be described in greater detail below, rotation of pin (31) aboutthe longitudinal axis of waveguide (38) causes concurrent rotation ofwaveguide (38) about the longitudinal axis of waveguide (38). As shownin FIGS. 17A and 17B, pin (31) extends through waveguide (38) and innertube (302) such that a first end of pin (31) is slidably disposed withincamming channel (304) and such that a second end of pin (31) is slidablydisposed within camming channel (306). As will be discussed in moredetail below, pin (31) is operable to slide within camming channels(304, 306) as inner tube (302) translates longitudinally relative towaveguide (38). This sliding of pin (31) within camming channels (304,306) causes rotation of pin (31) and waveguide (38) about thelongitudinal axis of waveguide (38).

FIGS. 17A and 17B show the steps of rotating waveguide (38) vialongitudinal translation of inner tube (302) relative to waveguide (38).With clamp arm (44) in an open position relative to ultrasonic blade(42), inner tube (302) is in a first longitudinal position as shown inFIG. 17A. In this first longitudinal position, pin (31) is disposedwithin a longitudinal portion (304A, 306A) of camming channels (304,306). At this stage, ultrasonic blade (42) and clamp arm (44) are bothoriented as shown in FIG. 3A. As inner tube (302) is translatedlongitudinally through a first range of motion relative to waveguide(38) and outer sheath (32), pin (31) slides within camming channels(304, 306) through longitudinal portions (304A, 306A) until clamp arm(44) reaches a closed position relative to ultrasonic blade (42),similar to the configuration shown in FIG. 3B. Alternatively, clamp arm(44) may be in a substantially closed position at this stage (e.g., suchthat clamp arm (44) defines a sharply acute angle with ultrasonic blade(42), substantially near the closed position).

As inner tube (302) continues to translate longitudinally through asecond range of motion relative to waveguide (38) and outer sheath (32),pin (31) slides through slanted portions (304B, 306B) of cammingchannels (304, 306), as shown in FIG. 17B. It should be understood that,as pin (31) is slid into slanted portions (304B, 306B), clamp arm (44)reaches or remains in a closed position relative to ultrasonic blade(42). As shown in FIG. 17B, movement of pin (31) within camming channels(304, 306) into slanted portions (304B, 306B) causes rotation ofwaveguide (38) and thus ultrasonic blade (42) about the longitudinalaxis of waveguide (38). Thus, it should be understood that ultrasonicblade (42) rotates as clamp arm (44) pivots toward ultrasonic blade (42)and clamps tissue there between.

In the present example, ultrasonic blade (42) is configured to reach astate of full apposition with clamp pad (46) along the length ofultrasonic blade (42) and clamp pad (46) (e.g., as shown in FIG. 3B)once pin (31) reaches the transition between longitudinal portions(304A, 306A) and slanted portions (304B, 306B). As inner tube (302) istranslated further relative to waveguide (38) and outer sheath (32) torotate waveguide (38) as shown in FIG. 17B, the curved configuration ofultrasonic blade (42) and the rotation of ultrasonic blade (42) togetherprovide a distally advancing rolling engagement, such that an increasedamount of compression force is applied between the distal end ofultrasonic blade (42) and clamp pad (46). Thus, the compression forcebetween the distal end of ultrasonic blade (42) and clamp pad (46)increases during the transition from the configuration shown in FIG. 17Ato the configuration shown in FIG. 17B. This increase in distalcompression may prevent formation of a tissue tag or cut a tissue tag atthe distal end of end effector (40).

While rotation mechanism (300) is discussed as being used withinstrument (10) in the present example, it should be understood thatrotation mechanism (300) may be readily incorporated into instrument(100).

G. Seventh Exemplary Ultrasonic Blade Rotation Mechanism

FIGS. 18-19B show yet another exemplary alternative ultrasonic bladerotation mechanism (320) that may be readily incorporated intoinstrument (10). Rotation mechanism (320) of the present examplecomprises an exemplary alternative inner tube (322). Inner tube (322) ofthe present example is configured to operate substantially similar toinner tubes (34, 302) discussed above except for the differencesdiscussed below. In particular, longitudinal translation of inner tube(322) relative to outer sheath (32) causes actuation of clamp arm (44)at end effector (40). Waveguide (38) of the present example is rotatablydisposed within inner tube (322) such that waveguide (38) is rotatablerelative to shaft assembly (30). Inner tube (322) comprises a pair ofcamming channels (324, 326) formed in diametrically opposite sides ofinner tube (322). While inner tube (322) is translatable relative toouter sheath (32) in this example, inner tube (322) does not rotaterelative to outer sheath (32) in this example.

As discussed above with reference to instrument (10), waveguide (38) issecured within shaft assembly (30) via a pin (31), which passes throughwaveguide (38) and shaft assembly (30). Pin (31) is located at aposition along the length of waveguide (38) corresponding to a nodeassociated with resonant ultrasonic vibrations communicated throughwaveguide (38). As will be described in greater detail below, rotationof pin (31) about the longitudinal axis of waveguide (38) causesconcurrent rotation of waveguide (38) about the longitudinal axis ofwaveguide (38). As shown in FIGS. 19A and 19B, pin (31) extends throughwaveguide (38) and inner tube (302) such that a first end of pin (31) isslidably disposed within camming channel (324) and such that a secondend of pin (31) is slidably disposed within camming channel (326). Aswill be discussed in more detail below, pin (31) is operable to slidewithin camming channels (324, 326) as inner tube (322) translateslongitudinally relative to waveguide (38). This sliding within cammingchannels (324, 326) causes rotation of waveguide (38) about thelongitudinal axis of waveguide (38).

FIGS. 19A and 19B show the steps of rotating waveguide (38) vialongitudinal translation of inner tube (322) relative to waveguide (38).With clamp arm (44) in an open position relative to ultrasonic blade(42), inner tube (322) is in a first longitudinal position as shown inFIG. 19A. In this first longitudinal position, pin (31) is disposedwithin a proximal longitudinal portion (324A, 326A) of camming channels(324, 326). At this stage, ultrasonic blade (42) and clamp arm (44) areboth oriented as shown in FIG. 3A. As inner tube (322) is translatedlongitudinally through a first range of motion relative to waveguide(38) and outer sheath (32), pin (31) slides within camming channels(324, 326) through proximal longitudinal portions (324A, 326A) untilclamp arm (44) reaches a closed position relative to ultrasonic blade(42), similar to the configuration shown in FIG. 3B. Alternatively,clamp arm (44) may be in a substantially closed position at this stage(e.g., such that clamp arm (44) defines a sharply acute angle withultrasonic blade (42), substantially near the closed position).

As inner tube (322) continues to translate longitudinally through asecond range of motion relative to waveguide (38) and outer sheath (32),pin (31) slides through slanted portions (324B, 326B) and into distallongitudinal portions (324C, 326C) as shown in FIG. 19B. It should beunderstood that, as pin (31) slides through slanted portions (324B,326B) and into distal longitudinal portions (324C, 326C), clamp arm (44)reaches or remains a closed position relative to ultrasonic blade (42).As shown in FIG. 19B, movement of pin (31) within camming channels (324,326) through slanted portions (324B, 326B) causes rotation of waveguide(38) and thus ultrasonic blade (42). Thus, it should be understood thatultrasonic blade (42) rotates as clamp arm (44) pivots toward ultrasonicblade (42) and clamps tissue there between.

In the present example, ultrasonic blade (42) is configured to reach astate of full apposition with clamp pad (46) along the length ofultrasonic blade (42) and clamp pad (46) (e.g., as shown in FIG. 3B)once pin (31) reaches slanted portions (324B, 326B). As inner tube (322)is translated further relative to waveguide (38) and outer sheath (32)to rotate waveguide (38) as shown in FIG. 19B, the curved configurationof ultrasonic blade (42) and the rotation of ultrasonic blade (42)together provide a distally advancing rolling engagement, such that anincreased amount of compression force is applied between the distal endof ultrasonic blade (42) and clamp pad (46). Thus, the compression forcebetween the distal end of ultrasonic blade (42) and clamp pad (46)increases during the transition from the configuration shown in FIG. 19Ato the configuration shown in FIG. 19B. This increase in distalcompression may prevent formation of a tissue tag or cut a tissue tag atthe distal end of end effector (40).

While rotation mechanism (320) is discussed as being used withinstrument (10) in the present example, it should be understood thatrotation mechanism (320) may be readily incorporated into instrument(100).

H. Eighth Exemplary Ultrasonic Blade Rotation Mechanism

FIGS. 20-21B show yet another exemplary alternative ultrasonic bladerotation mechanism (340) that may be readily incorporated intoinstrument (10). Rotation mechanism (340) of the present examplecomprises an exemplary alternative inner tube (342) and an exemplarytriggering mechanism (344). Inner tube (342) of the present example isconfigured to operate substantially similar to inner tube (34) discussedabove except for the differences discussed below. In particular,longitudinal translation of inner tube (342) relative to outer sheath(32) causes actuation of clamp arm (44) at end effector (40). Triggeringmechanism (344) of the present example is mechanically coupled totrigger (28) such that pivoting of trigger (28) toward and away frompistol grip (24) causes actuation of triggering mechanism (344). As willbe discussed in more detail below, actuation of triggering mechanism(344) causes rotation of waveguide (38).

Waveguide (38) of the present example is rotatably disposed within innertube (342) such that waveguide (38) is rotatable relative to shaftassembly (30). As discussed above with reference to instrument (10),waveguide (38) is secured within shaft assembly (30) via a pin (31),which passes transversely through waveguide (38) and shaft assembly(30). In particular, in the present example, pin (31) passes throughwaveguide (38) and into inner tube (342) such that pin (31) rotatesconcurrently with inner tube (342). Pin (31) is located at a positionalong the length of waveguide (38) corresponding to a node associatedwith resonant ultrasonic vibrations communicated through waveguide (38).As will be described in greater detail below, rotation of pin (31)causes concurrent rotation of waveguide (38).

Inner tube (322) comprises a camming channel (346) formed in side ofinner tube (342). Triggering mechanism (344) comprises a pin (345)projecting from a top surface of triggering mechanism (344) and intocamming channel (346). Pin (345) is slidably disposed within cammingchannel (346). It should be understood that pin (35) extends intocamming channel (346) but does not contact waveguide (38). As will bediscussed in more detail below, pin (345) is operable to slide withincamming channel (346) as inner tube (342) translates longitudinally.This sliding within camming channel (346) causes rotation of inner tube(342) and waveguide (38) about the longitudinal axis of waveguide viapin (31).

FIGS. 21A and 21B show the steps of rotating waveguide (38) viaactuation of triggering mechanism (344). (Triggering mechanism (344),expect for pin (345), has been omitted from FIGS. 21A and 21B for thesake of clarity.) With clamp arm (44) in an open position, pin (345) oftriggering mechanism (344) is in a first longitudinal position as shownin FIG. 21A. In this first longitudinal position, pin (345) is disposedwithin a distal longitudinal portion (346A) of camming channel (346). Astriggering mechanism (344) is actuated, pin (345) is translatedlongitudinally within camming channel (346) such that pin (345) slideswithin camming channel (346) from distal longitudinal portion (346A)through a slanted portion (346B) and into a proximal longitudinalportion (346C) as shown in FIG. 21B. It should be understood that as pin(345) slides through slanted portion (346B) and into proximallongitudinal portion (346C), clamp arm (44) is pivoted into a closedposition via longitudinal translation of inner tube (34) therebyclamping tissue within end effector (40). As shown in FIG. 21B, movementof pin (345) within camming channel (346) through slanted portion (346B)causes rotation of inner tube (342) and waveguide (38) via pin (31) andthus ultrasonic blade (42). Thus, it should be understood thatultrasonic blade (42) rotates as clamp arm (44) pivots toward ultrasonicblade (42) and clamps tissue therebetween.

In the present example, ultrasonic blade (42) is configured to reach astate of full apposition with clamp pad (46) along the length ofultrasonic blade (42) and clamp pad (46) (e.g., as shown in FIG. 3B)once pin (31) reaches slanted portion (346B). As pin (345) is drivenfurther through channel (346) to rotate waveguide (38) as shown in FIG.21B, the curved configuration of ultrasonic blade (42) and the rotationof ultrasonic blade (42) together provide a distally advancing rollingengagement, such that an increased amount of compression force isapplied between the distal end of ultrasonic blade (42) and clamp pad(46). Thus, the compression force between the distal end of ultrasonicblade (42) and clamp pad (46) increases during the transition from theconfiguration shown in FIG. 21A to the configuration shown in FIG. 21B.This increase in distal compression may prevent formation of a tissuetag or cut a tissue tag at the distal end of end effector (40).

While rotation mechanism (340) is discussed as being used withinstrument (10) in the present example, it should be understood thatrotation mechanism (340) may be readily incorporated into instrument(100).

I. Ninth Exemplary Ultrasonic Blade Rotation Mechanism

FIGS. 22A and 22B show yet another exemplary alternative ultrasonicblade rotation mechanism (360) that may be readily incorporated intoinstrument (100). Rotation mechanism (360) of the present examplecomprises an exemplary waveguide (362) and an exemplary pin (364). Byway of example only, pin (364) may be formed of stainless steel coatedwith hard plastic. Of course, any other suitable material(s) may beused. Waveguide (362) is configured to operate substantially similar towaveguide (138) discussed above except for the differences discussedbelow. In particular, waveguide (362) communicates acoustic vibrationsat ultrasonic frequencies to an ultrasonic blade (142) to thereby cutand/or seal tissue. Waveguide (362) of the present example is rotatablydisposed within shaft assembly (130) such that waveguide (362) isrotatable relative to shaft assembly (130). Waveguide (362) is securedwithin shaft assembly (130) via pin (364), which passes throughwaveguide (362) and shaft assembly (130). Pin (364) is located at aposition along the length of waveguide (362) corresponding to a nodeassociated with resonant ultrasonic vibrations communicated throughwaveguide (362).

As shown in FIGS. 22A and 22B, pin (364) passes through anhourglass-shaped passageway (363) formed in waveguide (362). Thus itshould be understood that waveguide (362) is operable to rotate relativeto pin (364) as pin (364) translates within passageway (363). Pin (364)extends from shaft assembly (130) and a top of pin (364) presents apaddle (367). Paddle (367) may be engaged by a user to drive verticaltranslation of pin (364) along a path that is transverse to thelongitudinal axis of waveguide (362). An interior surface of slot (363)of waveguide (362) presents an inwardly extending projection (368). Pin(364) has an inwardly directed recess (365) formed in an exterior of pin(364). Recess (365) of pin (364) is configured to receive projection(368) of slot (363) such that projection (368) engages pin (364) atrecess (365). As will be discussed in more detail below, this engagementbetween recess (365) and projection (368) is configured to allowvertical translation of pin (364) (along a path that is transverse tothe longitudinal axis of waveguide (362)) to cause rotation of waveguide(362) about the longitudinal axis of waveguide (362).

FIGS. 22A and 22B show the steps of rotating waveguide (362) viatranslation of pin (364). As shown in FIG. 22A, with pin (364) in afirst vertical position, waveguide (362) and ultrasonic blade (142) arein a first rotational position. In this position, recess (365) isengaged with projection (365). A user may drive pin (364) along a paththat is transverse to the longitudinal axis of waveguide (362), toward asecond vertical position as shown in FIG. 22B. Because of the engagementbetween recess (365) of pin (364) and projection (368) of slot (363) ofwaveguide (362), the downward movement of pin (364) causes rotation ofwaveguide (362) and ultrasonic blade (142) about the longitudinal axisof waveguide (362). It should be understood that pin (364) may beactuated by the operator to rotate waveguide (362) and ultrasonic blade(142) at any time. For instance, the operator may actuate pin (364) bypressing paddle (367) when tissue is clamped within end effector (140).The curved configuration of ultrasonic blade (142) and the rotation ofultrasonic blade (142) together provide a distally advancing rollingengagement, such that an increased amount of compression force isapplied between the distal end of ultrasonic blade (142) and clamp pad(146) as ultrasonic blade (142) is rotated. Thus, the compression forcebetween the distal end of ultrasonic blade (142) and clamp pad (146)increases during the transition from the configuration shown in FIG. 22Ato the configuration shown in FIG. 22B. This increase in distalcompression may prevent formation of a tissue tag or cut a tissue tag atthe distal end of end effector (140).

In some versions, paddle (367) or some other feature of pin (364) isconfigured and positioned such that shank (152) will drive pin (364)from the position shown in FIG. 22A to the position shown in FIG. 22Bonce clamp arm assembly (150) is pivoted within a certain range towardshaft assembly (130). By way of example only, pin (364) may beconfigured such that end effector (140) may reach a state of fullclosure, with ultrasonic blade (142) in full apposition with clamp pad(146), before shank (152) engages pin (364). Once clamp arm assembly(150) is pivoted further toward shaft assembly (130) after end effector(140) reaches this state, shank (152) drives pin (364) from the positionshown in FIG. 22A to the position shown in FIG. 22B, thereby providing arolling engagement between ultrasonic blade (142) and clamp pad (146).It should further be understood that waveguide (362) may be resilientlybiased toward the first rotational position shown in FIG. 22A, such thatwaveguide (362) returns to the position shown in FIG. 22A as soon as theoperator relaxes their grip on grip rings (124, 154). By way of exampleonly, such resilient bias may be provided by a torsion spring orelastomeric bushing engaged with waveguide (362), a coil spring urgingpin (364) to the position shown in FIG. 22A, and/or some other feature.It should also be understood that rotation mechanism (360) may include aselective locking feature that is operable to selectively lock waveguide(362) into the position shown in FIG. 22B. This may promote the use ofthe distal end of end effector (140) to make smaller “nibble” types ofincisions in tissue. Various suitable features that may be used toprovide such selective locking will be apparent to those of ordinaryskill in the art in view of the teachings herein. As yet another merelyillustrative variation, pin (364) may be configured to provide a camfeature similar to projection (368), such that slot (363) simply has anhourglass configuration. The cam feature of pin (364) may thus bearagainst the surface defining the hourglass shaped slot (363), to therebyprovide rotation of waveguide (362) in response to pin (364) movingalong a path that is transverse to the longitudinal axis of waveguide(362).

While rotation mechanism (360) is discussed as being incorporated intoinstrument (100) in the present example, it should be understood thatrotation mechanism (360) may be readily incorporated into instrument(10).

III. Exemplary Ultrasonic Surgical Instruments with Clamp Arm RotationMechanisms

As noted above, it may be desirable to provide some degree of relativerotation between an ultrasonic blade (42, 142) and a clamp arm (44, 144)in order to prevent or otherwise address the occurrence of tissue tagsin tissue that is clamped between ultrasonic blade (42, 142) and clamparm (44, 144). The various examples described above provide rotation ofultrasonic blade (42, 142) and waveguide (38, 138) relative to the restof instrument (10, 100), to thereby provide rotation of ultrasonic blade(42, 142) relative to clamp arm (44, 144). By contrast, the examplesdescribed below provide rotation of clamp arm (44, 144) relative to therest of instrument (10, 100), to thereby provide rotation of clamp arm(44, 144) relative to ultrasonic blade (42, 142). It should beunderstood that such rotation of clamp arm (44, 144) relative toultrasonic blade (42, 142) may be just as effective at preventing orotherwise addressing the occurrence of tissue tags as the rotation ofultrasonic blade (42, 142) relative to clamp arm (144). It should beunderstood that the below examples may be viewed as variations ofinstruments (10, 100), such that various teachings below may be readilycombined with various teachings above as will be apparent to those ofordinary skill in the art.

A. First Exemplary Clamp Arm Rotation Mechanism

FIGS. 23-25F show an exemplary clamp arm rotation mechanism (400) thatmay be readily incorporated into instrument (100). Outer sheath (132) ofthe present example comprises a first portion (132A) and a secondportion (132B). First portion (132A) and second portion (132B) arerotatably coupled together such that second portion (132B) is rotatablerelative to first portion (132A). Clamp arm assembly (150) is pivotallycoupled with second portion (132B) of outer sheath (132) via pin (156).Thus it should be understood that clamp arm assembly (150), includingclamp arm (144), is rotatable relative to first portion (132A) of outersheath (132). In particular, clamp arm assembly (150) and second portion(132B) are together rotatable relative to first portion (132A) and theremainder of instrument (100), about the longitudinal axis of waveguide(138). Rotation mechanism (400) of the present example comprises alongitudinally translatable locking member (410). As will be discussedin more detail below, locking member (410) is configured to selectivelyengage a plurality of tabs (402A, 402B, 402C, 402D) extending outwardlyfrom an exterior surface of second portion (132B) to thereby selectivelyprevent and/or allow rotation of second portion (132B) and clamp armassembly (150) relative to first portion (132A) and the remainder ofinstrument (100). Locking member (410) is keyed to second portion (132B)such that locking member translates relative to second portion (132B)yet locking member (410) rotates concomitantly with second portion(132B).

FIGS. 24A and 24B show the steps of selectively locking and unlockingsecond portion (132B) via locking member (410) of rotation mechanism(400) to thereby prevent and/or allow rotation of second portion (132B)and clamp arm assembly (150). Plurality of tabs (402A, 402B, 402C, 402D)extend outwardly from the exterior surface of second portion (132B) anddefine gaps in between respective tabs (402A, 402B, 402C, 402D). In afirst longitudinal position, an inwardly extending tab (412) of lockingmember (410) is positioned within a particular gap defined by aparticular pair of plurality of tabs (402A, 402B, 402C, 402D) as shownin FIG. 24A. In this position, because tab (412) of locking member (410)is within the particular gap defined by tabs (402A, 402B, 402C, 402D),second portion (132B) of outer sheath (132) and clamp arm assembly (150)may not be rotated relative to first portion (132A). Also as shown inFIG. 24A, locking member (410) is biased proximally toward this firstlongitudinal position via a coil spring (414) bearing against a distalsurface of locking member (410) and a proximal surface of second portion(132B). Of course, a coil spring (414) is just an example and any othersuitable type of resilient feature may be used.

A user may translate locking member (410) longitudinally distally into asecond longitudinal position such that tab (412) is no longer within theparticular gap defined by tabs (402A, 402B, 402C, 402D) and such thattab (412) no longer engages tabs (402A, 402B, 402C, 402D). FIG. 24Bshows locking member (410) in such a second longitudinal position. Inthis second longitudinal position, because tab (412) no longer engagestabs (402A, 402B, 402C, 402D), second portion (132B) of outer sheath(132) and clamp arm assembly (150) may be rotated relative to firstportion (132A). Once the operator has achieved a desired angularorientation of second portion (132B) and clamp arm assembly (150)relative to first portion (132A) and the remainder of instrument (100),the operator may release locking member (410). Upon the release oflocking member (410), coil spring (414) will drive locking member (410)back to the proximal position shown in FIG. 24A, such that tab (412)will be located in a gap defined by tabs (402A, 402B, 402C, 402D). Tabs(412, 402A, 402B, 402C, 402D) will thus effectively lock the selectedangular orientation of second portion (132B) and clamp arm assembly(150) relative to first portion (132A) and the remainder of instrument(100). It should be understood that tabs (412, 402A, 402B, 402C, 402D)are just one merely illustrative example and that various other kinds offeatures may be used, including but not limited to detent features,clamping features, etc. Furthermore, while tabs (412, 402A, 402B, 402C,402D) provide a limited number of angular orientations, other versionsmay provide an infinite adjustability of the angular orientation withina 360° range or lesser angular range.

FIGS. 25A, 25C, and 25E show various rotational positions of secondportion (132B) and clamp arm assembly (150); while FIGS. 25B, 25D, and25F show the corresponding rotational positions of clamp arm (144)relative to ultrasonic blade (142). FIGS. 25A and 25B show secondportion (132B) or outer sheath (132), clamp arm assembly (150), andclamp arm (144) in a first rotational position. In this first rotationalposition, tab (412) of locking member (410) is disposed within a gapdefined by tabs (402B, 402C) of outer sheath (132). Clamp arm (144) isparallel to ultrasonic blade (142) such that the entire length of clamppad (146) engages ultrasonic blade (142) as clamp arm (144) is closedtoward ultrasonic blade (142).

FIGS. 25C and 25D show second portion (132B) or outer sheath (132),clamp arm assembly (150), and clamp arm (144) in a second rotationalposition. In this second rotational position, tab (412) of lockingmember (410) is disposed within a gap defined by tabs (402C, 402D) ofouter sheath (132). Clamp arm (144) is angled obliquely relative toultrasonic blade (142) such that the distal end of clamp pad (146)engages ultrasonic blade (142) first as clamp arm (144) is closed towardultrasonic blade (142). In other words, the second rotational positionis associated with a tip-loaded configuration for end effector (140).Such a tip-loaded configuration may be used to prevent tissue tags thatmight otherwise be left by end effector (140) if end effector (140) wereactuated with ultrasonic blade (142) oriented substantially parallel toclamp pad (146). In addition or in the alternative, such a tip-loadedconfiguration may promote the use of the distal end of end effector(140) to make smaller “nibble” types of incisions in tissue. In someinstances, after the distal end of clamp pad (146) engages ultrasonicblade (142) during closure of clamp arm (144), clamp arm (144) may movefurther through a second range of closure motion whereby the rest of thelength of clamp pad (146) engages ultrasonic blade (142). For instance,clamp arm (144) and clamp pad (146) may provide some degree ofdeformability.

FIGS. 25E and 25F show second portion (132B) or outer sheath (132),clamp arm assembly (150), and clamp arm (144) in a third rotationalposition. In this third rotational position, tab (412) of locking member(410) is disposed within a gap defined by tabs (402A, 402B) of outersheath (132). Clamp arm (144) is angled obliquely relative to ultrasonicblade (142) such that the proximal end of clamp pad (146) engagesultrasonic blade (142) first as clamp arm (144) is closed towardultrasonic blade (142). In other words, the second rotational positionis associated with a proximal-loaded configuration for end effector(140). Such a proximal-loaded configuration may be used to preventtissue tags that might otherwise be left by end effector (140) if endeffector (140) were actuated with ultrasonic blade (142) orientedsubstantially parallel to clamp pad (146). In some instances, after theproximal end of clamp pad (146) engages ultrasonic blade (142) duringclosure of clamp arm (144), clamp arm (144) may move further through asecond range of closure motion whereby the rest of the length of clamppad (146) engages ultrasonic blade (142). For instance, clamp arm (144)and clamp pad (146) may provide some degree of deformability.

It should be understood that the gaps defined by tabs (402A, 402B, 402C,402D) may be arranged in an angular array about the exterior surface ofsecond portion (132B) of outer sheath (132) such that any angulardistance exists between each gap. For instance, the gaps may be at anangular distance of 45° from one another and/or any other suitableangular distance. While rotation mechanism (400) is discussed as beingincorporated into instrument (100) in the present example, it should beunderstood that rotation mechanism (400) may be readily incorporatedinto instrument (10).

B. Second Exemplary Clamp Arm Rotation Mechanism

FIGS. 26-28C show an exemplary alternative clamp arm rotation mechanism(420) that may be readily incorporated into instrument (100). Rotationmechanism (420) of the present example comprises an exemplaryalternative outer sheath (422) and an exemplary alternative clamp arm(424). Outer sheath (422) of the present example is configured tooperate substantially similar to outer sheath (132) discussed aboveexcept for the differences discussed below. In particular, outer sheath(422) extends distally from body (122) of handle assembly (120). Clamparm (424) is pivotably coupled with outer sheath (422). Clamp arm (424)of the present example is configured to operate substantially similar toclamp arm (44) discussed above except for the differences discussedbelow. In particular, clamp arm (424) is an integral feature of clamparm assembly (150) and is pivotable toward and away from ultrasonicblade (142) based on pivoting of thumb grip ring (154) toward and awayfrom body (122) of handle assembly (120). Clamp pad (146) is integrallysecured to clamp arm (424).

Outer sheath (422) presents a pair of semi-spherical projections (423A,423B) disposed on opposite sides of outer sheath (424). Clamp arm (424)comprises a pair of semi-spherical recesses (425A, 425B). In some otherversions, semi-spherical recesses (425A, 425B) are substituted withopenings. Semi-spherical recesses (425A, 425B) are configured to receiveand engage semi-spherical projections (423A, 423B) of outer sheath(422). Clamp arm (424) may be configured to provide an inward bias tosemi-spherical recesses (425A, 425B) such that semi-spherical recesses(425A, 425B) retain clamp arm (424) on semi-spherical projections (423A,423B) during operation of instrument (100).

The configurations of semi-spherical projections (423A, 423B) andsemi-spherical recesses (425A, 425B) is configured to allow clamp armassembly (150), including clamp arm (424) to rotate about multiple axesrelative to outer sheath (422), waveguide (138), and ultrasonic blade(142). For instance, the engagement between semi-spherical projections(423A, 423B) and semi-spherical recesses (425A, 425B) allows clamp arm(424) to move toward and away from ultrasonic blade (142) about a firstpivot axis (421) as shown in FIGS. 27A and 27B. Additionally, theengagement between semi-spherical projections (423A, 423B) andsemi-spherical recesses (425A, 425B) allows clamp arm (424) to movelaterally relative to ultrasonic blade (142) about a second pivot axis(423) as shown in FIGS. 28A-28C. In use, after the operator has clampedtissue between clamp arm (424) and ultrasonic blade (142) by drivingclamp arm assembly (150) about first pivot axis (421) as shown in FIGS.27A and 28A, and after the operator has activated ultrasonic blade (142)to vibrate ultrasonically to sever and seal the clamped tissue, theoperator may then drive clamp arm assembly (150) in a lateral rockingmotion about second pivot axis (423) as shown in FIGS. 28B-28C whileholding clamp arm (424) in a clamped position about first pivot axis(421). This lateral movement of clamp arm (424) relative to ultrasonicblade (142) may prevent or cut tissue tags that might otherwise bepresent in the absence of such lateral movement. In some versions, oneor more resilient members (e.g., wave springs, etc.) resiliently biasclamp arm (424) to the laterally centered position about second pivotaxis (423) as shown in FIG. 28A; while still permitting clamp arm (424)to be deflected laterally about second pivot axis (423) as shown inFIGS. 28B-28C.

It should be understood that the lateral movement depicted in FIGS.28B-28C may be exaggerated, such that the actual lateral movement ofclamp arm (424) relative to ultrasonic blade (142) about second pivotaxis (423) may not be nearly as pronounced as it is in FIGS. 28B-28C. Itshould also be understood that outer sheath (422) and/or one or moreother features of instrument (100) may include a cam feature that drivesclamp arm (424) laterally in the direction shown in FIG. 28B and/or inthe direction shown in FIG. 28C during closure of clamp arm (424). Forinstance, such a cam feature may permit clamp arm (424) to first reach astate of parallel closure as shown in FIGS. 27A and 28A after clamp armassembly (150) is pivoted a first range of motion about first pivot axis(421). Then if clamp arm assembly (150) is further pivoted through asecond range of motion about first pivot axis (421), after clamp arm(424) has reached the state of parallel closure as shown in FIGS. 27Aand 28A, the cam feature may drive clamp arm (424) laterally about thesecond pivot axis (423) in the direction shown in FIG. 28B and/or in thedirection shown in FIG. 28C. It should be understood that clamp arm(424) and/or shank (152) may provide some degree of deformability toenable clamp arm assembly (150) to be driven through the second range ofmotion after clamp arm (424) has reached the state of parallel closureas shown in FIGS. 27A and 28A.

C. Third Exemplary Clamp Arm Rotation Mechanism

FIGS. 29-31C show another exemplary alternative clamp arm rotationmechanism (440) that may be readily incorporated into instrument (100).Rotation mechanism (440) of the present example comprises an exemplaryalternative outer sheath (442). Outer sheath (442) of the presentexample is configured to operate substantially similar to outer sheath(132) discussed above except for the differences discussed below. Inparticular, outer sheath (442) extends distally from body (122) ofhandle assembly (120). Outer sheath (442) of the present examplecomprises a rotatable member (444). Clamp arm (144) is pivotably coupledwith a rotatable member (444) of outer sheath (442) via pin (156).

As best seen in FIG. 30, rotatable member (444) is rotatably coupledwith a distal end of outer sheath (442) and a proximal end of cap (134)such that rotatable member (444) is operable to rotate about thelongitudinal axis of waveguide (138) relative to outer sheath (442). Asnoted above, clamp arm (144) is pivotably coupled with rotatable member(444). It should therefore be understood that clamp arm (144) and clamparm assembly (150) are rotatable together about the longitudinal axis ofwaveguide (138) relative to outer sheath (442). FIGS. 31A-31C showrotation of clamp arm (144), clamp arm assembly (150), and rotatablemember (444) about the longitudinal axis of waveguide (138) relative toouter sheath (442). It should be understood that clamp arm (144), clamparm assembly (150), and rotatable member (444) are capable of rotating360° about the longitudinal axis of waveguide (138) relative to outersheath (442). It should also be appreciated that, at any point ofrotation about the longitudinal axis of waveguide (138), clamp armassembly (150) and clamp arm (144) may be pivoted toward and way fromultrasonic blade (142) to thereby clamp tissue.

In use, after the operator has clamped tissue between clamp arm (144)and ultrasonic blade (142) by driving clamp arm assembly (150) about theaxis defined by pin (156) as shown in FIG. 31A, and after the operatorhas activated ultrasonic blade (142) to vibrate ultrasonically to severand seal the clamped tissue, the operator may then drive clamp armassembly (150) in a rotational motion about the axis defined bywaveguide (138) as shown in FIGS. 31B-31C, while holding clamp arm (144)in a clamped position. This rotational movement of clamp arm (144) aboutthe axis defined by waveguide (138), relative to ultrasonic blade (142),may prevent or cut tissue tags that might otherwise be present in theabsence of such additional rotational movement.

While rotation mechanism (440) is discussed as being incorporated intoinstrument (100) in the present example, it should be understood thatrotation mechanism (440) may be readily incorporated into instrument(10).

IV. Exemplary Rotational Support Devices

As discussed above, it may be desirable to provide mechanisms that allowwaveguide (38, 138), ultrasonic blade (42, 142), and/or clamp arm (44,144) to be selectively rotated relative to other components ofinstrument (10, 100). Waveguide (38, 138) and ultrasonic blade (42, 142)are secured to shaft assembly (30, 130) via pin (31, 133). Thus, it mayfurther be desirable to provide rotational features that allow somedegree of rotation of pin (31, 133) relative to shaft assembly (30,130), to thereby enable rotation of waveguide (38, 138), ultrasonicblade (42, 142), and pin (31, 133) together relative to shaft assembly(30, 130). Various illustrative examples of an instrument that includesuch rotational features will be described in greater detail below,while other examples will be apparent to those of ordinary skill in theart in view of the teachings herein. It should be understood that thebelow examples may be viewed as variations of instruments (10, 100),such that various teachings below may be readily combined with variousteachings above as will be apparent to those of ordinary skill in theart.

A. First Exemplary Rotational Support Device

FIGS. 32-33F show an exemplary rotational device (500) that may bereadily incorporated into instrument (100). Rotational device (500) ofthe present example comprises an exemplary alternative waveguide (502).Waveguide (502) is configured to operate substantially similar towaveguide (138) discussed above except for the differences discussedbelow. In particular, waveguide (502) communicates acoustic vibrationsat ultrasonic frequencies from an ultrasonic transducer to an ultrasonicblade (503) to thereby cut and/or seal tissue. As shown in FIGS. 33A,33C, and 33E, pin (133) passes through an hourglass-shaped slot (504)formed in waveguide (502). Slot (504) of the present example is filledwith a flexible elastomeric material (506), such that pin (133) isembedded within elastomeric material (506).

Waveguide (502) is operable to rotate relative to pin (133) as pin (133)rotates within slot (504). Pin (133) extends from waveguide (502) andinto outer sheath (132) such that pin (133) remains stationary aswaveguide (502) is rotated relative to pin (133) and outer sheath (132).Elastomeric material (506) provides sufficient flexibility to allowrotation of waveguide (502) relative to pin (133) as shown in FIGS. 33Cand 33E; yet elastomeric material (506) also provides sufficientresilience to bias waveguide (502) to the nominal angular position shownin FIG. 33A.

FIGS. 33A, 33C, and 33E show rotational positions of waveguide (502);and FIGS. 33B, 33D, and 33F show the corresponding rotational positionsof ultrasonic blade (503) relative to clamp arm (144). FIGS. 33A and 33Bshow waveguide (502) and ultrasonic blade (503) in a first rotationalposition. In this first rotational position, pin (133) is substantiallycentered within slot (504). Clamp arm (144) is parallel to ultrasonicblade (503) such that the entire length of ultrasonic blade (503)engages clamp pad (146) as clamp arm (144) is closed toward ultrasonicblade (503). Instrument (100) may include a knob and/or one or moreother features that allow the operator to rotate waveguide (502) aboutthe longitudinal axis of waveguide (502), relative to pin (133) andouter sheath (132). For instance, the operator may rotate waveguide(502) about the longitudinal axis of waveguide (502), relative to pin(133) and outer sheath (132), to the angular position shown in FIG. 33Cand/or to the angular position shown in FIG. 33E. Alternatively, as willbe described in greater detail below, waveguide (502) may be resilientlybiased to the angular position shown in FIG. 33C or to the angularposition shown in FIG. 33E.

FIGS. 33C and 33D show waveguide (502) and ultrasonic blade (503) in asecond rotational position. In this second rotational position,waveguide (502) has been rotated counter-clockwise such that pin (133)is oriented obliquely within slot (504). Ultrasonic blade (503) isangled obliquely relative to clamp arm (144) such that the distal end ofultrasonic blade (503) engages clamp pad (146) first as clamp arm (144)is closed toward ultrasonic blade (503). In other words, the secondrotational position is associated with a tip-loaded configuration forend effector (140). Such a tip-loaded configuration may be used toprevent tissue tags that might otherwise be left by end effector (140)if end effector (140) were actuated with ultrasonic blade (503) orientedsubstantially parallel to clamp pad (146). In addition or in thealternative, such a tip-loaded configuration may promote the use of thedistal end of end effector (140) to make smaller “nibble” types ofincisions in tissue. In some instances, after the distal end ofultrasonic blade (503) engages clamp pad (146) during closure of clamparm (144), clamp arm (144) may move further through a second range ofclosure motion whereby the rest of the length of ultrasonic blade (503)engages clamp pad (146). For instance, elastomeric material (506) maydeform to provide rotation of waveguide (502) from the position shown inFIG. 33C to the position shown in FIG. 33A as clamp arm (144) movesthrough the second range of motion. It should also be understood thatthe configuration of and relationship between pin (133) and elastomericmaterial (506) may provide the configuration of FIGS. 33C-33D as anominal, default configuration, such that blade (503) is essentiallybiased to the tip-loaded configuration shown in FIGS. 33C-33D.

FIGS. 33E and 33F show waveguide (502) and ultrasonic blade (503) in athird rotational position. In this third rotational position, waveguide(502) has been rotated clockwise such that pin (133) is orientedobliquely within slot (504), in an opposite direction from the nominalplane. Ultrasonic blade (503) is angled obliquely relative to clamp arm(144) such that the proximal end of ultrasonic blade (503) engages clamppad (146) first as clamp arm (144) is closed toward ultrasonic blade(503). In other words, the third rotational position is associated witha proximal-loaded configuration for end effector (140). Such aproximal-loaded configuration may be used to prevent tissue tags thatmight otherwise be left by end effector (140) if end effector (140) wereactuated with ultrasonic blade (503) oriented substantially parallel toclamp pad (146). In some instances, after the proximal end of ultrasonicblade (503) engages clamp pad (146) during closure of clamp arm (144),clamp arm (144) may move further through a second range of closuremotion whereby the rest of the length of ultrasonic blade (503) engagesclamp pad (146). For instance, elastomeric material (506) may deform toprovide rotation of waveguide (502) from the position shown in FIG. 33Eto the position shown in FIG. 33A as clamp arm (144) moves through thesecond range of motion. It should also be understood that theconfiguration of and relationship between pin (133) and elastomericmaterial (506) may provide the configuration of FIGS. 33E-33F as anominal, default configuration, such that blade (503) is essentiallybiased to the proximal-loaded configuration shown in FIGS. 33E-33F.

While rotational device (500) is discussed as being incorporated intoinstrument (100) in the present example, it should be understood thatrotational device (500) may be readily incorporated into instrument(10).

B. Second Exemplary Rotational Support Device

FIG. 34 shows an exemplary alternative rotational device (510) that maybe readily incorporated into instrument (100). Rotational device (510)comprises an elastomeric bushing (512) that is secured within outersheath (132) of shaft assembly (130). Pin (133) passes through waveguide(138) at a position along the length of waveguide (138) corresponding toa node associated with resonant ultrasonic vibrations communicatedthrough waveguide (138). The free ends of pin (133) are embedded withinelastomeric bushing (512). Elastomeric bushing (512) provides sufficientflexibility to allow rotation of waveguide (138) and pin (133) about thelongitudinal axis of waveguide (138) relative to outer sheath (132); yetelastomeric bushing (512) also provides sufficient resilience to biaswaveguide (138) and pin (133) to a nominal angular position about thelongitudinal axis of waveguide (138) relative to outer sheath (132).

In some versions, elastomeric bushing (512) biases waveguide (138) andpin (133) to a nominal angular position about the longitudinal axis ofwaveguide (138) relative to outer sheath (132) where end effector (140)is in a tip-loaded configuration, similar to what is shown in FIG. 33D.Thus, as the operator pivotally drives clamp arm assembly (150) towardshaft assembly (130), the distal end of ultrasonic blade (142) engagesclamp pad (146) first as clamp arm (144) is closed toward ultrasonicblade (142). After the distal end of ultrasonic blade (142) engagesclamp pad (146) during closure of clamp arm (144), clamp arm (144) maymove further through a second range of closure motion whereby the restof the length of ultrasonic blade (142) engages clamp pad (146). Forinstance, elastomeric bushing (512) may deform to provide rotation ofultrasonic blade (142) from a position similar to that shown in FIG. 33Dto the position similar to that shown in FIG. 33B as clamp arm (144)moves through the second range of motion. As the operator relaxes theirgrip on grip rings (124, 154), allowing clamp arm assembly (150) topivot back away from shaft assembly (130), the resilient bias ofelastomeric bushing (512) drives ultrasonic blade (142) back to thedistal-loaded angular orientation.

In some other versions, elastomeric bushing (512) biases waveguide (138)and pin (133) to a nominal angular position about the longitudinal axisof waveguide (138) relative to outer sheath (132) where end effector(140) is in a proximal-loaded configuration, similar to what is shown inFIG. 33F. Thus, as the operator pivotally drives clamp arm assembly(150) toward shaft assembly (130), the proximal end of ultrasonic blade(142) engages clamp pad (146) first as clamp arm (144) is closed towardultrasonic blade (142). After the proximal end of ultrasonic blade (142)engages clamp pad (146) during closure of clamp arm (144), clamp arm(144) may move further through a second range of closure motion wherebythe rest of the length of ultrasonic blade (142) engages clamp pad(146). For instance, elastomeric bushing (512) may deform to providerotation of ultrasonic blade (142) from a position similar to that shownin FIG. 33F to the position similar to that shown in FIG. 33B as clamparm (144) moves through the second range of motion. As the operatorrelaxes their grip on grip rings (124, 154), allowing clamp arm assembly(150) to pivot back away from shaft assembly (130), the resilient biasof elastomeric bushing (512) drives ultrasonic blade (142) back to theproximal-loaded angular orientation.

In still other versions, elastomeric bushing (512) biases waveguide(138) and pin (133) to a nominal angular position about the longitudinalaxis of waveguide (138) relative to outer sheath (132) where ultrasonicblade (142) is parallel to clamp arm (144), such that the entire lengthof ultrasonic blade (142) engages clamp pad (146) as clamp arm (144) isclosed toward ultrasonic blade (503), similar to what is shown in FIG.33B. Instrument (100) may include a knob and/or one or more otherfeatures that allow the operator to rotate waveguide (138) about thelongitudinal axis of waveguide (138), relative to shaft assembly (130)and clamp arm assembly (150). For instance, the operator may rotatewaveguide (138) about the longitudinal axis of waveguide (138), relativeto shaft assembly (130) and clamp arm assembly (150), to the orientultrasonic blade (142) at an angular position similar to the one shownin FIG. 33C and/or the one shown in FIG. 33E. This may be done whiletissue is clamped between ultrasonic blade (142) and clamp pad (146).The rotation of ultrasonic blade (142) while tissue is clamped betweenultrasonic blade (142) and clamp pad (146) may cut any tissue tags thatmight otherwise be left in tissue clamped between ultrasonic blade (142)and clamp pad (146).

In addition to providing a resilient bias and deformability, elastomericbushing (512) may also dampen rotational vibration of waveguide (138)and/or noise from pin (133) to shaft assembly (130). It should also beunderstood that elastomeric bushing (512) may be configured to providegreater rotational compliance than axial compliance. In some variations,elastomeric bushing (512) is replaced with some other resilient member.By way of example only, rotational device (510) may instead comprise oneor more leaf springs that are interposed between pin (133) and shaftassembly (130), to resiliently bias waveguide (138) to some nominalangular position while still allowing waveguide to rotate from thatnominal angular position about the longitudinal axis of waveguide (138).Other suitable ways in which rotational device (510) may be configuredwill be apparent to those of ordinary skill in the art in view of thetahings herein. While rotational device (510) is discussed as beingincorporated into instrument (100) in the present example, it should beunderstood that rotational device (510) may be readily incorporated intoinstrument (10).

V. Exemplary End Effector Variations

The examples described above provide modified relative movement betweenultrasonic blade (42, 142) and clamp arm (44, 144) in order to preventor otherwise address the occurrence of tissue tags. It should also beunderstood that the configuration of ultrasonic blade (42, 142) and/orclamp arm (44, 144) may also be modified in order to prevent orotherwise address the occurrence of tissue tags. Such modifications maybe provided in addition to or in lieu of modifying the relative movementbetween ultrasonic blade (42, 142) and clamp arm (44, 144). Variousmerely illustrative examples of modifications to ultrasonic blade (42,142) and clamp arm (44, 144) are described in greater detail below;while still other examples will be apparent to those of ordinary skillin the art in view of the teachings herein. It should be understood thatthe below examples may be viewed as variations of instruments (10, 100),such that various teachings below may be readily combined with variousteachings above as will be apparent to those of ordinary skill in theart.

A. Exemplary Ultrasonic Blade Variation

FIGS. 35-37 show an exemplary ultrasonic blade (600) that may be readilyincorporated into instrument (100). Ultrasonic blade (600) of thepresent example is configured to operate substantially similar toultrasonic blade (142) discussed above except for the differencesdiscussed below. In particular, ultrasonic blade (600) is operable totransect and/or seal tissue clamped between clamp arm (144) andultrasonic blade (600). A proximal portion of ultrasonic blade (600)comprises a pair of angled cutouts (602A, 602B) formed in opposite sidesof ultrasonic blade (600). Angled cutouts (602A, 602B) define a bottomsurface (604) having a minimized contact area. Angled cutouts (602A,602B) and bottom surface (604) define a V-shaped profile configured tobear against tissue clamped between ultrasonic blade (600) and clamp pad(146) of clamp arm (144). The minimal contact area presented by bottomsurface (604) causes a greater amount of pressure to be applied totissue clamped between the proximal portion of ultrasonic blade (600)and clamp pad (146) than would otherwise be applied in the absence ofangled cutouts (602A, 602B). It should therefore be understood thatultrasonic blade (600) is operable to apply an increased amount ofpressure to tissue clamped between the proximal portion of ultrasonicblade (600) and clamp pad (146) to thereby prevent the formation oftissue tags at the region of angled cutouts (602A, 602B). While angledcutouts (602A, 602B) are formed in the proximal portion of ultrasonicblade (600) in this example, it should be understood that angled cutouts(602A, 602B) may be defined in any appropriate portion of ultrasonicblade (600) and along any suitable length of ultrasonic blade (600). Forinstance, angled cutouts (602A, 602B) and may be formed in a distalportion of ultrasonic blade (600).

While ultrasonic blade (600) is discussed as being incorporated intoinstrument (100) in the present example, it should be understood thatultrasonic blade (600) may be readily incorporated into instrument (10).

B. Exemplary Clamp Pad Variation

FIGS. 38-39 show an exemplary clamp pad (610) that may be readilyincorporated into instrument (100). Clamp pad (610) of the presentexample is configured to operate substantially similar to clamp pad(146) discussed above except for the differences discussed below. Inparticular, clamp pad (610) is secured to clamp arm (144) such thattissue may be clamped between clamp pad (610) and ultrasonic blade (142)to transect and/or seal the tissue. Clamp pad (610) of the presentexample comprises a plurality of electrodes (612, 614, 616, 618)disposed along the length of clamp pad (610) in a spaced-apartrelationship, as best seen in FIG. 39.

Electrodes (612, 614, 616, 618) are provided as pairs that areconfigured to measure electrical impedance across the clamped tissuethat is positioned between the electrodes (612, 614, 616, 618) of eachpair. In other words, the distal-most pair of electrodes (618) may senseelectrical impedance across clamped tissue that is positioned betweenthe distal-most pair of electrodes (618), the proximal-most pair ofelectrodes (612) may sense electrical impedance across clamped tissuethat is positioned between the proximal-most pair of electrodes (618),and so on. Electrodes (612, 614, 616, 618) may all sense impedancesimultaneously or in a sequence (e.g., beginning at the distal-most pairof electrodes (618) and ending at the proximal-most pair of electrodes(618), etc.). Electrodes (612, 614, 616, 618) may also sense impedancemany times per second.

If any particular pair of electrodes (612, 614, 616, 618) sense animpedance value above a certain threshold, this may indicate that thereis no tissue positioned between that particular pair of electrodes (612,614, 616, 618). If any particular pair of electrodes (612, 614, 616,618) sense an impedance value below a certain threshold, this mayindicate that there is tissue positioned between that particular pair ofelectrodes (612, 614, 616, 618). Electrodes (612, 614, 616, 618) maythus collectively sense the distribution of tissue along the length ofclamp pad (610). In the example shown in FIG. 40, electrodes (612, 614)each sense a respective level of electrical impedance (612A, 614A) abovepredetermined threshold (619) such that electrodes (612, 614) sense theabsence of tissue in the region of clamp pad (610) monitored byelectrodes (612, 614). Additionally, electrodes (616, 618) each sense arespective level of electrical impedance (616A, 618A) belowpredetermined threshold (619) such that electrodes (616, 618) sense thepresence of tissue in the region of clamp pad (610) monitored byelectrodes (616, 618).

Electrodes (612, 614, 616, 618) may be in communication with a controlmodule (e.g., microprocessor, ASIC, etc.) that is operable to execute acontrol logic based upon the distribution of tissue along the length ofclamp pad (610) as sensed by electrodes (612, 614, 616, 618). Thiscontrol module may also be in communication with a feature that isoperable to rotate clamp arm (144) relative to ultrasonic blade (142);and/or rotate ultrasonic blade (142) relative to clamp arm (144). By wayof example only, the control module may be in communication with afeature like motor (242) as described above with respect to the exampledepicted in FIGS. 10-11D. Once the presence of tissue is sensed betweenone or more pairs of electrodes (612, 614, 616, 618), the control modulemay drive motor (242) or some other feature to provide relative rotationbetween ultrasonic blade (142) and clamp arm (144) to provide increasedpressure at the distal ends of clamp pad (610) and ultrasonic blade(142) or at the proximal ends of clamp pad (610) and ultrasonic blade(142), based on the sensed location of tissue along the length of clamppad (610). In addition to or as an alternative to driving a feature likemotor (242), the control module may also provide audible and/or visualfeedback to the operator to indicate where tissue is positioned alongthe length of clamp pad (610), based on impedance values sensed byelectrodes (612, 614, 616, 618).

While the control module drives a feature like motor (242) to provide arolling contact between clamp pad (610) and ultrasonic blade (142), thecontrol module may continue to monitor the impedance values sensed byelectrodes (612, 614, 616, 618). If the control module adjusts therelative angular positioning of clamp pad (610) and ultrasonic blade(142), and determines based on impedance values sensed by electrodes(612, 614, 616, 618) that there is still tissue positioned between clamppad (610) and ultrasonic blade (142), the control module may continue todrive a feature like motor (242) to continue adjusting the relativeangular positioning of clamp pad (610) and ultrasonic blade (142). Forinstance, clamp pad (610) and/or ultrasonic blade (142) may be slowly orrapidly rocked about a longitudinal axis in an oscillatory motion untilall electrodes (612, 614, 616, 618) sense an impedance value above thethreshold. In addition or in the alternative, the control module maydrive a user feedback feature that indicates to the user when allelectrodes (612, 614, 616, 618) sense an impedance value above thethreshold, which may indicate that the entire length of tissue betweenclamp pad (610) and ultrasonic blade (142) has been cut without leavingtissue tags. Still other suitable ways in which an instrument (100)incorporating clamp pad (610) may be operated will be apparent to thoseof ordinary skill in the art in view of the teachings herein.

While clamp pad (610) is discussed as being incorporated into instrument(100) in the present example, it should be understood that clamp pad(610) and associated features may be readily incorporated intoinstrument (10).

C. Exemplary Clamp Arm and Pin Variation

FIGS. 41A-42 show an exemplary clamp arm (620) and pivot pin (622) thatmay be readily incorporated into instrument (100). Clamp arm (620) isconfigured to operate substantially similar to clamp arm (144) discussedabove except for the differences discussed below. In particular, clamparm (620) is an integral feature of clamp arm assembly (150) and ispivotable toward and away from ultrasonic blade (142) based on pivotingof thumb grip ring (154) toward and away from body (122) of handleassembly (120). Pivot pin (622) is configured to operate substantiallysimilar to pin (156) discussed above except for the differencesdiscussed below. For instance, clamp arm assembly (150), including clamparm (620), is pivotally coupled with outer sheath (132) via pin (622).Clamp arm (620) of the present example comprises a passageway (621)through which pin (622) passes to thereby pivotably couple clamp arm(620) with outer sheath (132). As best seen in FIGS. 41A-41C, passageway(621) comprises a circular profile, whereas, as best seen in FIG. 42,pin (622) comprises a teardrop-shaped profile. The teardrop-shapedprofile of pin (622) includes a circular region (622A) and asubstantially linear region (622B). Circular region (622A) is configuredto bear against an interior surface of the circular profile ofpassageway (621), whereas a gap exists between the substantially linearregion (622B) and the circular profile of passageway (621).

As previously discussed, clamp arm (620) and ultrasonic blade (142) areoperable to clamp tissue. A portion of the force applied to this tissuevia clamp arm (620) and ultrasonic blade (142) is transferred to pin(622). With clamp arm (620) in an open position, as shown in FIG. 41A,force applied to clamped tissue will be applied to circular region(622A) of pivot pin (622) via clamp arm (620) as represented by arrow(624) such that this force is incapable of moving clamp arm (620)upwardly or downwardly due to contact between circular region (622A) andthe interior surface of the circular profile of passageway (621). Withclamp arm (620) moved into a partially closed position, as shown in FIG.41B, force applied to clamped tissue will be transmitted to circularregion (622A) of pivot pin (622) via clamp arm (620), as represented byarrow (624), such that this force is incapable of moving clamp arm (620)upwardly or downwardly due to contact between circular region (622A) andthe interior surface of the circular profile of passageway (621). Withclamp arm (620) moved into a fully closed position, as shown in FIG.41C, force applied to clamped tissue will be applied to linear region(622B) of pivot pin (622) via clamp arm (620), as represented by arrow(624), such that this force is capable of moving clamp arm (620)upwardly or downwardly due to clearance provided by the gap that existsbetween linear region (622A) and the interior surface of the circularprofile of passageway (621). It should therefore be understood that inthe fully closed position, clamp arm (620) may be moved upwardly anddownwardly in a linear fashion relative to ultrasonic blade (142).

In some versions, pivot pin (622) is configured to allow end effector(140) to reach a full state of closure before clamp arm (620) may bemoved upwardly and downwardly in a linear fashion relative to ultrasonicblade (142). In other words, clamp arm (620) may only move in a pivotalfashion relative to ultrasonic blade (142) when clamp arm (620)transitions from an open position to a closed position. Thus, theoperator may first feel a hard stop when clamp arm (620) reaches theclosed position, before clamp arm (620) may moves upwardly anddownwardly in a linear fashion relative to ultrasonic blade (142). Theoperator may then continue to actuate clamp arm (620) further afterreaching the closed position to provide additional linearly directedcompression force on tissue captured between clamp arm (620) andultrasonic blade. It should also be understood that the ultrasonic powerdelivered to ultrasonic blade (142) may be varied based on the state ofclosure of clamp arm (620).

FIG. 43 shows an exemplary alternative pin (632). A first end of pin(632) comprises a tear-shaped profile, whereas a second end of pin (632)comprises a circular profile. The tear-shaped profile of pin (632)includes a circular region (632A) and a substantially linear region(632B). It should be understood that the circular profile of pin (632)would provide a substantial gap between the circular profile and theinterior surface of passageway (621). This substantial gap would allowfor movement of clamp arm (620) in an upwardly and downwardly direction,as well as laterally relative to ultrasonic blade (142). This additionalupward/downward movement and lateral movement may be provided afterclamp arm (620) reaches a state of closure as described above, such thatthe additional upward/downward movement and lateral movement would beapplied after tissue has been at least initially compressed betweenclamp arm (620) and ultrasonic blade.

While pins (622, 632) have been described as being incorporated intoinstrument (100), it should be understood that pins (622, 632) mayalternatively be readily incorporated into instrument (10).

VI. Miscellaneous

It should be understood that any of the versions of instrumentsdescribed herein may include various other features in addition to or inlieu of those described above. By way of example only, any of theinstruments described herein may also include one or more of the variousfeatures disclosed in any of the various references that areincorporated by reference herein. It should also be understood that theteachings herein may be readily applied to any of the instrumentsdescribed in any of the other references cited herein, such that theteachings herein may be readily combined with the teachings of any ofthe references cited herein in numerous ways. Other types of instrumentsinto which the teachings herein may be incorporated will be apparent tothose of ordinary skill in the art.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures. By way of example only, various teachingsherein may be readily incorporated into a robotic surgical system suchas the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, Calif.Similarly, those of ordinary skill in the art will recognize thatvarious teachings herein may be readily combined with various teachingsof U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool withUltrasound Cauterizing and Cutting Instrument,” published Aug. 31, 2004,the disclosure of which is incorporated by reference herein.

Versions described above may be designed to be disposed of after asingle use, or they can be designed to be used multiple times. Versionsmay, in either or both cases, be reconditioned for reuse after at leastone use. Reconditioning may include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, someversions of the device may be disassembled, and any number of theparticular pieces or parts of the device may be selectively replaced orremoved in any combination. Upon cleaning and/or replacement ofparticular parts, some versions of the device may be reassembled forsubsequent use either at a reconditioning facility, or by a userimmediately prior to a procedure. Those skilled in the art willappreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

We claim:
 1. An apparatus for operating on tissue, the apparatuscomprising: (a) a body assembly; (b) a shaft assembly extending distallyfrom the body assembly, wherein the shaft assembly comprises an acousticwaveguide operable to transmit ultrasonic vibrations, wherein theacoustic waveguide defines a longitudinal axis; (c) an ultrasonic bladein acoustic communication with the acoustic waveguide; (d) a clampassembly, wherein the clamp assembly comprises a clamp arm pivotabletoward and away from the ultrasonic blade about a pivot axis, whereinthe clamp assembly further comprises a driving element, wherein theclamp arm is configured to movably actuate the driving element of theclamp assembly relative to the body assembly as the clamp arm pivotstoward and away from the ultrasonic blade; and (e) a rotation feature,wherein the driving element of the clamp assembly is configured toengage the rotation feature in response to pivoting of the clamp armtoward and away from the ultrasonic blade to thereby rotatably drive therotation feature based on pivotal positioning of the clamp arm relativeto the ultrasonic blade about the pivot axis, wherein the rotationfeature is operable to be rotatably driven by the driving element of theclamp assembly to rotate the ultrasonic blade relative to the clamp armabout the longitudinal axis.
 2. The apparatus of claim 1, wherein theultrasonic blade has a curved section curving along a path that deviatesfrom the longitudinal axis, wherein the clamp arm has a curved sectioncurving along the path that deviates from the longitudinal axis, suchthat the curvature of the curved section of the clamp arm complementsthe curvature of the curved section of the ultrasonic blade.
 3. Theapparatus of claim 1, wherein the rotation feature comprises: (i) arack, and (ii) a gear configured to engage with the rack.
 4. Theapparatus of claim 3, wherein the gear is coaxially disposed about thewaveguide, wherein the rack extends transversely relative to the clamparm.
 5. The apparatus of claim 1, wherein the rotation feature comprisesa motor.
 6. The apparatus of claim 1, wherein the waveguide isresiliently biased toward a first rotational position about thelongitudinal axis.
 7. The apparatus of claim 1, wherein the rotationfeature comprises: (i) a pin disposed transversely through thewaveguide, and (ii) an elongate member extending from the clampassembly, wherein the elongate member is configured to engage the pinand thereby rotate the ultrasonic blade about the longitudinal axis inresponse to the clamp arm completing a first range of travel about thepivot axis toward a closed position.
 8. The apparatus of claim 1,wherein the rotation feature comprises a bushing secured to thewaveguide, wherein the bushing is configured to cause rotation of theultrasonic blade relative to the clamp arm about the longitudinal axisin response to contact between the bushing and the clamp assembly. 9.The apparatus of claim 1, wherein the rotation feature comprises: (i) awaveguide pin disposed transversely through the waveguide, and (ii) atube having at least one cam channel, wherein the tube is coaxiallydisposed about the longitudinal axis, wherein the tube is movablerelative to the longitudinal axis to rotate the waveguide pin about thelongitudinal axis.
 10. The apparatus of claim 9, wherein the tube isoperable to translate along the longitudinal axis, wherein the waveguidepin is disposed in the at least one cam channel such that the waveguidepin is configured to rotate about the longitudinal axis in response totranslation of the tube along the longitudinal axis.
 11. The apparatusof claim 9, wherein the tube is operable to rotate about thelongitudinal axis, wherein the waveguide pin is fixedly secured to thetube, wherein the rotation feature further comprises a drive pindisposed in the cam channel, wherein the drive pin is operable totranslate relative to the longitudinal axis to thereby rotate the tubeand the waveguide pin about the longitudinal axis.
 12. The apparatus ofclaim 1, wherein the rotation feature comprises a pin disposedtransversely through the waveguide, wherein the pin is operable totranslate along a path transverse to the longitudinal axis to therebyrotate the ultrasonic blade relative to the clamp arm about thelongitudinal axis.
 13. The apparatus of claim 1, wherein the rotationfeature comprises: (i) a pin disposed transversely through thewaveguide, and (ii) a resilient feature interposed between at least aportion of the pin and at least a portion of the waveguide.
 14. Theapparatus of claim 13, wherein the resilient feature comprises anelastomeric material.
 15. The apparatus of claim 13, wherein theresilient feature is configured to bias the clamp arm and the ultrasonicblade in an obliquely offset angular relationship such that either: (i)proximal portions of the clamp arm and the ultrasonic blade engage eachother first during pivotal movement of the clamp arm toward theultrasonic blade about the pivot axis, or (ii) distal portions of theclamp arm and the ultrasonic blade engage each other first during apivotal movement of the clamp arm toward the ultrasonic blade about thepivot axis.
 16. The apparatus of claim 1, further comprising one or moresensor elements operable to sense positioning of tissue between theultrasonic blade and the clamp arm, wherein the rotation feature isconfigured to respond to positioning of tissue between the ultrasonicblade and the clamp arm as sensed by the one or more sensor elements.17. An apparatus for operating on tissue, the apparatus comprising: (a)a body assembly; (b) a shaft assembly extending distally from the bodyassembly, wherein the shaft assembly comprises an acoustic waveguideoperable to transmit ultrasonic vibrations, wherein the acousticwaveguide defines a longitudinal axis; (c) an ultrasonic blade inacoustic communication with the acoustic waveguide; (d) a clamp armpivotable toward and away from the ultrasonic blade about a pivot axis;and (e) a rotation feature engaged with an engaged portion of the clamparm, wherein the rotation feature is operable to drive rotation of theultrasonic blade about the longitudinal axis, wherein the rotationfeature is configured to be driven by the engaged portion of the clamparm based on movement of the clamp arm relative to the ultrasonic bladeabout the pivot axis to thereby drive rotation of the ultrasonic bladeabout the longitudinal axis in response to pivotal movement of the clamparm relative to the ultrasonic blade about the pivot axis.
 18. Theapparatus of claim 17, wherein the rotation feature comprises a pindisposed transversely through the waveguide, wherein the pin is operableto translate along a path to thereby rotate the ultrasonic blade aboutthe longitudinal axis relative to the clamp arm.
 19. An apparatus foroperating on tissue, the apparatus comprising: (a) a body assembly; (b)a shaft assembly extending distally from the body assembly, wherein theshaft assembly comprises an acoustic waveguide operable to transmitultrasonic vibrations, wherein the acoustic waveguide defines alongitudinal axis; (c) an ultrasonic blade in acoustic communicationwith the acoustic waveguide; (d) a clamp arm pivotable toward and awayfrom the ultrasonic blade about a pivot axis; and (e) a rotation featureoperable to drive rotation of the ultrasonic blade about thelongitudinal axis, wherein the rotation feature is attached to eitherthe ultrasonic blade or the acoustic waveguide, wherein the rotationfeature is positioned and configured to be driven by movement of aportion of the clamp arm relative to the ultrasonic blade about thepivot axis such that the rotation feature is operable to drive rotationof the ultrasonic blade about the longitudinal axis in response topivotal movement of the clamp arm about the pivot axis.
 20. Theapparatus of claim 19, wherein the rotation feature comprises a pindisposed transversely through the waveguide, wherein the pin is operableto translate along a path to thereby rotate the ultrasonic blade aboutthe longitudinal axis relative to the clamp arm.
 21. An apparatus foroperating on tissue, the apparatus comprising: (a) a body assembly; (b)a shaft assembly extending distally from the body assembly, wherein theshaft assembly comprises an acoustic waveguide operable to transmitultrasonic vibrations, wherein the acoustic waveguide defines alongitudinal axis; (c) an ultrasonic blade in acoustic communicationwith the acoustic waveguide; (d) a clamp assembly, wherein the clampassembly comprises a clamp arm pivotable toward and away from theultrasonic blade about a pivot axis; and (e) a rotation feature, whereinan engaged portion of the clamp arm is engaged with the rotationfeature, wherein the rotation feature is configured to be driven byactuation of the engaged portion of the clamp arm based on pivotalpositioning of the clamp arm relative to the ultrasonic blade about thepivot axis, wherein the rotation feature is operable to be driven by theengaged portion of the clamp arm to rotate the ultrasonic blade relativeto the clamp arm about the longitudinal axis.